拆 婦科腹腔鏡微創(chuàng)手術(shù) 婦科腹腔鏡微創(chuàng)手術(shù)簡(jiǎn)介在人類文明邁向21世紀(jì)之時(shí)，醫(yī)學(xué)發(fā)展也進(jìn)入了一個(gè)嶄新的時(shí)代。隨著科學(xué)技術(shù)和醫(yī)療水平的提高，醫(yī)療已不僅僅局限于治愈疾病，如何減少治療時(shí)的并發(fā)癥，如何使婦科手術(shù)真正做到只切除病灶而不損傷正常組織，如何從根本上預(yù)防疾病的發(fā)生，已成為當(dāng)今醫(yī)療質(zhì)量的更高追求。腹腔鏡微創(chuàng)手術(shù)是指以最小的創(chuàng)傷、最佳的治療手段達(dá)到治愈疾病。腹腔鏡手術(shù)是一門(mén)新發(fā)展起來(lái)的微創(chuàng)方法，是未來(lái)手術(shù)方法發(fā)展的一個(gè)必然趨勢(shì)。加上醫(yī)生越來(lái)越嫻熟的操作，使得許多過(guò)去的開(kāi)放性手術(shù)現(xiàn)在已被腔內(nèi)手術(shù)取而代之，大大增加了手術(shù)選擇機(jī)會(huì)。 腹腔鏡是一種帶有微型攝像頭的器械。腹腔鏡手術(shù)就是利用腹腔鏡及其相關(guān)器械進(jìn)行的手術(shù)：使用冷光源提供照明，將腹腔鏡鏡頭插入腹腔內(nèi)，運(yùn)用數(shù)字?jǐn)z像技術(shù)使腹腔鏡鏡頭拍攝到的圖像通過(guò)光導(dǎo)纖維傳導(dǎo)，并且實(shí)時(shí)顯示在專用監(jiān)視器上。然后醫(yī)生通過(guò)監(jiān)視器屏幕上所顯示患者器官不同角度的圖像，對(duì)病人的病情進(jìn)行分析判斷，并且運(yùn)用特殊的腹腔鏡器械進(jìn)行手術(shù)。腹腔鏡微創(chuàng)手術(shù)的過(guò)程Minimally invasive laparoscopic surgery微創(chuàng)腹腔鏡手術(shù)是醫(yī)生運(yùn)用集光學(xué)、計(jì)算機(jī)、超聲、機(jī)械等技術(shù)的特殊腹腔鏡器械進(jìn)行的手術(shù)。手術(shù)的基本過(guò)程是：病人麻醉后，醫(yī)生在病人的腹壁打34個(gè)直徑0.51厘米的小孔，其中的一個(gè)孔放入鏡子。鏡子通過(guò)微型攝像機(jī)連接到電視屏幕上，使得病人腹腔內(nèi)的病灶一目了然地反映到電視屏幕上。而其他幾個(gè)腹壁小孔則放入剪刀、鉗子等手術(shù)器械，醫(yī)生看著屏幕進(jìn)行手術(shù)。手術(shù)過(guò)程基本與開(kāi)腹手術(shù)一樣，由于鏡子具有放大810倍的作用，甚至可以做得比開(kāi)腹手術(shù)還要精細(xì)，醫(yī)生看著屏幕對(duì)病變的組織進(jìn)行鉗夾、切割、縫合等一系列操作。同時(shí)，手術(shù)中應(yīng)用電刀、激光、微波等先進(jìn)技術(shù)，使得手術(shù)更趨完善。最后，將切除的腫塊放入塑料袋內(nèi)切碎后取出。 The minimally invasive laparoscopic surgery is the surgery doctors make by applying a special set of laparoscope apparatuses, such as optics, computer, ultrasonic and mechanics. The basic procedure of the surgery is as follows.After a patient is narcotized, doctors punch 3 to 4 holes of 0.5 to 1cm in diameter in the patients abdominal wall. A mirror is put into one of the holes. The mirror is connected to TV screens by a mini-camera and the nidus in the enterocoelia of the patient are displayed on the screens obviously. Surgery apparatuses like Scissors, pliers and so on are put into the left holes. The doctors make the surgery by watching the TV screens. The process of the surgery is the same as laparotomy. The surgery may be more meticulous than laparotomy due to 8 to 10 times of amplification by the mirror. The doctors can make a series of operation, such as clamping, cutting and stitching by watching the TV screens. At the same time, the application of advanced technologies like electrotome, laser, microwave and so can make the surgery more perfect. Finally, the tumor is put into a plastic bag and is chopped, and then the bag with chopped tumor inside is taken out.從1982年開(kāi)展簡(jiǎn)單婦科腹腔鏡手術(shù)。1989年Reich首次報(bào)道腹腔鏡下子宮全切術(shù)，到90年代大部分婦科手術(shù)在腹腔鏡下完成。如宮外孕、子宮肌瘤等。腹腔鏡手術(shù)能治療以下婦科疾?。鹤訉m肌瘤、子宮肌腺瘤、卵巢腫瘤、卵巢畸胎瘤、子宮內(nèi)膜癌、宮外孕、不孕癥等。 Simple laparoscopic surgery was carried out as early as 1982. In 1989, Reich reported firstly hysterectomy by laparoscope. Most of the gynecological surgery was completed by laparoscope 1990s, such as ectopic pregnancy and uterine fibroids. Laparoscopic surgery can cure the following gynecological diseases: uterine fibroids, uterine adenomyosis, ovarian tumors, ovarian teratoma, endometrial cancer, ectopic pregnancy, infertility and so on.腹腔鏡手術(shù)與傳統(tǒng)手術(shù)相比具有以下優(yōu)點(diǎn)： 1、術(shù)后恢復(fù)快，住院時(shí)間短。術(shù)后次日可吃半流質(zhì)食物，并能下床活動(dòng)，一周后可恢復(fù)正常生活、工作。 2、生活質(zhì)量高。傳統(tǒng)手術(shù)疤痕較長(zhǎng)，腹腔鏡手術(shù)切口隱蔽，不留明顯疤痕，局部美觀，腹壁堅(jiān)韌。 3、腹腔鏡攝像頭具有放大作用，能清楚顯示體內(nèi)組織的細(xì)微結(jié)構(gòu)，與傳統(tǒng)開(kāi)腹手術(shù)相比，視野更清晰，因此手術(shù)更加準(zhǔn)確、精細(xì)，有效避免了手術(shù)部位以外臟器受到不必要的干擾，且術(shù)中出血少，手術(shù)更安全。 4、手術(shù)創(chuàng)傷小，術(shù)后疼痛輕。一般病人術(shù)后不需用止痛藥，創(chuàng)口僅用創(chuàng)可貼即可，不需拆線。 5、術(shù)后早期即可隨意翻身、活動(dòng)，腸功能恢復(fù)快，大大減少了腸粘連的發(fā)生，對(duì)生育影響輕。 Laparoscopic surgery has the following advantages compared with conventional surgery:1. Postoperative recovery is rapid and staying in hospital is short. The patient can eat semi-liquid food and walk off bed and will resume normal life and work after the surgery of one week. 2. The life quality is high. Conventional surgery leaves a long scar, however the incision of laparoscopic surgery is hidden and leaves no obvious scar, being artistic in locality, tenacious in abdominal wall.3. The laparoscopic camera has the function of amplification and can clearly show the fine structure of the body tissue. Compared with traditional open surgery, laparoscopic surgery is more accurate and more delicate, thus effectively avoiding unnecessary interference with the organs outside the surgical site, blooding less and being safer.4. Surgical trauma is small and postoperative pain is light. Generally, patients dont need to take analgesics. Wound is as small as only Band-Aid is stuck and there is no need to take out stitches.5. The patients can turn over on bed and move after early postoperative period, can be free to stand up, activities and intestinal function is recovered soon, greatly reducing the intestinal adhesion and having light impact on fertility.1.腹腔鏡設(shè)備昂貴操作較復(fù)雜。需要腹腔鏡外科再培訓(xùn)，對(duì)手術(shù)醫(yī)師有技術(shù)要求。 2. 術(shù)前難以估計(jì)手術(shù)時(shí)間，特殊情況需要術(shù)中改為開(kāi)腹手術(shù)。 3. 腹腔鏡手術(shù)在特殊情況下手術(shù)危險(xiǎn)增加。Laparoscopic surgery has the following disadvantages compared with conventional surgery:1. Laparoscopic facilities are expensive and more complicated in operation. Doctors to do laparoscopic surgery need training and the surgery has technical requirements of the surgeons.2. Duration of surgery is difficult to be estimated. The surgery would be changed into open surgery under special circumstances.3. Laparoscopic surgery increases risk under special circumstances.The indications of minimally invasive laparoscopic surgeryThere actually are 4 factors for selection of indications, namely, the patients and their disease, the surgeon and the surgical methods. The good selection is that the four must be fully fitted. Any surgery would produce complications of any surgery. Minimally invasive surgery should more completely avoid and reduce complications.Laparoscopic surgery we conduct currently exists risk factors, such as the limited observation of laparoscope and short of touch feeling when making the surgery by using robot hands. Energy source operation of various systems is the source of damage. The damage like bleeding or organ damage caused by microscope surgery is more difficult to be treated and it would be a thorny problem if it is not timely detected. Special complications like aeroembolism and are sometimes fatal.Therefore, the surgery should not be made worse than opening abdomen or similar to it. It should be made better and safer, or it would make the minimally invasive become a huge trauma. A mature gynecologist should master a variety of surgical methods and have his or her own specialty.腹腔鏡微創(chuàng)手術(shù)的適應(yīng)證適應(yīng)證的選擇實(shí)際上是4個(gè)要素，即病人及其疾病，術(shù)者及其術(shù)式，這4項(xiàng)必須完全契合才是好的選擇，任何手術(shù)都可能產(chǎn)生并發(fā)癥，而微創(chuàng)手術(shù)就更應(yīng)該避免和減少并發(fā)癥。目前我們所施行的微創(chuàng)手術(shù)都有產(chǎn)生并發(fā)癥的“危險(xiǎn)”因素：腹腔鏡的觀察視野局限，通過(guò)機(jī)械手完成操作，缺乏觸摸感覺(jué)。各種系統(tǒng)能源之操作實(shí)際也是損傷之源。鏡下的手術(shù)所發(fā)生的損傷，如出血或臟器損傷的處理較為困難，且有在術(shù)中不能及時(shí)發(fā)現(xiàn)，均成為棘手問(wèn)題。特別的并發(fā)癥問(wèn)題，如氣栓有時(shí)甚至是致命的。 因此，這些術(shù)式的實(shí)施要做得不比開(kāi)腹差或者相當(dāng)，應(yīng)該更好.更安全，否則“微創(chuàng)”可以變?yōu)椤熬迍?chuàng)”。一個(gè)成熟的婦科醫(yī)生應(yīng)該掌握各種手術(shù)方式，又善于形成自己的特長(zhǎng)。 Notice of minimally invasive laparoscopic surgeryBefore surgery, good personal hygiene should be kept and umbilicus should be cleaned with warm water; in the diet, the day before surgery the patient should eat light and easily digestible food meat and fish in order to prevent postoperative flatulence; the patient must prepare well, psychological status should be kept well and have enough sleep; we must prepare yourself mentally, to adjust the state of mind to ensure adequate sleep. Sedative drugs should be taken doctors say its necessary.腹腔鏡微創(chuàng)手術(shù)注意事項(xiàng)手術(shù)前，要注意個(gè)人衛(wèi)生，對(duì)臍部要用溫水洗干凈，在飲食方面，術(shù)前一天應(yīng)以清淡、易消化食物為主，切忌大魚(yú)大肉，以防引起術(shù)后腸脹氣。同時(shí)，要做好思想準(zhǔn)備，調(diào)整心理狀態(tài)，保證充足睡眠。必要時(shí)遵醫(yī)囑口服鎮(zhèn)靜藥物。 The effect of surgery should be consolidated for the patient and the patient should recuperate as quickly as possible after surgery. So the patient must abide by the following:1.The patient should adopt the supine position without pillow after six hours of surgery and head to the side in order to prevent vomit from being inhalating to trachea;2. Most patients dont have postoperative pain. Dont ignore to massage the patients waist and legs and turn over the patient to promote blood circulation and to prevent bedsores from occurring;3. Catheter can be unplugged on the surgery day and the patient should be encouraged to get out of bed and walk;4. The patient is allowed to eat a small amount of liquid diet after 6 hours of the surgery, such as a thin rice soup, noodle soup and so on. The patient shouldnt have sugary drinks, such as sweet milk and soy milk powder;5. The incision of the laparoscopic surgical is only 1 cm, so surgical abdominal dressing can be removed, and the patient can take a shower and then can gradually resume normal activities a week after the surgery. Appropriate and light movement a week after the surgery is necessary to make the body recover soon.腹腔鏡手術(shù)切口僅1厘米，因此一周后腹部敷料即可去掉，并可淋浴，然后即可逐步恢復(fù)正?；顒?dòng)。在一周前還是要注意適當(dāng)、輕便活動(dòng)，使身體早日復(fù)原。 手術(shù)后要注意鞏固手術(shù)效果，盡快恢復(fù)體力，為此要做到： 一、術(shù)后6小時(shí)內(nèi)，采用去枕平臥位，頭側(cè)向一邊，防止嘔吐物吸入氣管； 二、因術(shù)后大多數(shù)患者