Tantitamit Tanitra, Temtanakitpaisan Teerayut, Lee Chyi-Long
Department of Obstetrics and Gynecology, Faculty of Medicine, Srinakarinwirot University, Nakhon Nayok, Thailand.
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
Gynecol Minim Invasive Ther. 2019 Aug 29;8(3):129-131. doi: 10.4103/GMIT.GMIT_87_18. eCollection 2019 Jul-Sep.
Adhesion at the vesicouterine fold presents a great challenge when performing hysterectomy through transvaginal natural orifice transluminal endoscopy surgery (NOTES) in women with a history of cesarean section. An attempt to lyse adhesions often prolongs the procedure and may inadvertently result in cystostomy. The purpose of this report is to demonstrate a safe technique for the lysis of vesicouterine adhesions during NOTES hysterectomy. We present the cases of two patients with a history of cesarean section. Severe adhesions at the vesicouterine peritoneum were encountered in both cases, and one patient had an extensive adhesion involving lower half of the uterus. Although the lateral approach is sufficient in most cases, it does not allow a surgeon to approach the peritoneal cavity if there is extensive adhesion. In cases such as these, direct dissection of the adhesion on the uterus is required.
对于有剖宫产史的女性，经阴道自然腔道内镜手术（NOTES）行子宫切除术时，膀胱子宫襞粘连是一个巨大挑战。试图松解粘连往往会延长手术时间，且可能意外导致膀胱造口术。本报告的目的是展示一种在NOTES子宫切除术中安全松解膀胱子宫粘连的技术。我们介绍了两名有剖宫产史患者的病例。两例均在膀胱子宫腹膜处遇到严重粘连，其中一例患者粘连广泛，累及子宫下半部。尽管在大多数情况下侧方入路就足够了，但如果存在广泛粘连，外科医生无法进入腹腔。在这类病例中，需要直接解剖子宫上的粘连。
