微创手术综述.doc

拆 妇科腹腔镜微创手术 妇科腹腔镜微创手术简介在人类文明迈向21世纪之时，医学发展也进入了一个崭新的时代。随着科学技术和医疗水平的提高，医疗已不仅仅局限于治愈疾病，如何减少治疗时的并发症，如何使妇科手术真正做到只切除病灶而不损伤正常组织，如何从根本上预防疾病的发生，已成为当今医疗质量的更高追求。腹腔镜微创手术是指以最小的创伤、最佳的治疗手段达到治愈疾病。腹腔镜手术是一门新发展起来的微创方法，是未来手术方法发展的一个必然趋势。加上医生越来越娴熟的操作，使得许多过去的开放性手术现在已被腔内手术取而代之，大大增加了手术选择机会。 腹腔镜是一种带有微型摄像头的器械。腹腔镜手术就是利用腹腔镜及其相关器械进行的手术：使用冷光源提供照明，将腹腔镜镜头插入腹腔内，运用数字摄像技术使腹腔镜镜头拍摄到的图像通过光导纤维传导，并且实时显示在专用监视器上。然后医生通过监视器屏幕上所显示患者器官不同角度的图像，对病人的病情进行分析判断，并且运用特殊的腹腔镜器械进行手术。腹腔镜微创手术的过程Minimally invasive laparoscopic surgery微创腹腔镜手术是医生运用集光学、计算机、超声、机械等技术的特殊腹腔镜器械进行的手术。手术的基本过程是：病人麻醉后，医生在病人的腹壁打34个直径0.51厘米的小孔，其中的一个孔放入镜子。镜子通过微型摄像机连接到电视屏幕上，使得病人腹腔内的病灶一目了然地反映到电视屏幕上。而其他几个腹壁小孔则放入剪刀、钳子等手术器械，医生看着屏幕进行手术。手术过程基本与开腹手术一样，由于镜子具有放大810倍的作用，甚至可以做得比开腹手术还要精细，医生看着屏幕对病变的组织进行钳夹、切割、缝合等一系列操作。同时，手术中应用电刀、激光、微波等先进技术，使得手术更趋完善。最后，将切除的肿块放入塑料袋内切碎后取出。 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.从1982年开展简单妇科腹腔镜手术。1989年Reich首次报道腹腔镜下子宫全切术，到90年代大部分妇科手术在腹腔镜下完成。如宫外孕、子宫肌瘤等。腹腔镜手术能治疗以下妇科疾病：子宫肌瘤、子宫肌腺瘤、卵巢肿瘤、卵巢畸胎瘤、子宫内膜癌、宫外孕、不孕症等。 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.腹腔镜手术与传统手术相比具有以下优点： 1、术后恢复快，住院时间短。术后次日可吃半流质食物，并能下床活动，一周后可恢复正常生活、工作。 2、生活质量高。传统手术疤痕较长，腹腔镜手术切口隐蔽，不留明显疤痕，局部美观，腹壁坚韧。 3、腹腔镜摄像头具有放大作用，能清楚显示体内组织的细微结构，与传统开腹手术相比，视野更清晰，因此手术更加准确、精细，有效避免了手术部位以外脏器受到不必要的干扰，且术中出血少，手术更安全。 4、手术创伤小，术后疼痛轻。一般病人术后不需用止痛药，创口仅用创可贴即可，不需拆线。 5、术后早期即可随意翻身、活动，肠功能恢复快，大大减少了肠粘连的发生，对生育影响轻。 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.腹腔镜设备昂贵操作较复杂。需要腹腔镜外科再培训，对手术医师有技术要求。 2. 术前难以估计手术时间，特殊情况需要术中改为开腹手术。 3. 腹腔镜手术在特殊情况下手术危险增加。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.腹腔镜微创手术的适应证适应证的选择实际上是4个要素，即病人及其疾病，术者及其术式，这4项必须完全契合才是好的选择，任何手术都可能产生并发症，而微创手术就更应该避免和减少并发症。目前我们所施行的微创手术都有产生并发症的“危险”因素：腹腔镜的观察视野局限，通过机械手完成操作，缺乏触摸感觉。各种系统能源之操作实际也是损伤之源。镜下的手术所发生的损伤，如出血或脏器损伤的处理较为困难，且有在术中不能及时发现，均成为棘手问题。特别的并发症问题，如气栓有时甚至是致命的。 因此，这些术式的实施要做得不比开腹差或者相当，应该更好.更安全，否则“微创”可以变为“巨创”。一个成熟的妇科医生应该掌握各种手术方式，又善于形成自己的特长。 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.腹腔镜微创手术注意事项手术前，要注意个人卫生，对脐部要用温水洗干净，在饮食方面，术前一天应以清淡、易消化食物为主，切忌大鱼大肉，以防引起术后肠胀气。同时，要做好思想准备，调整心理状态，保证充足睡眠。必要时遵医嘱口服镇静药物。 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.腹腔镜手术切口仅1厘米，因此一周后腹部敷料即可去掉，并可淋浴，然后即可逐步恢复正常活动。在一周前还是要注意适当、轻便活动，使身体早日复原。 手术后要注意巩固手术效果，尽快恢复体力，为此要做到： 一、术后6小时内，采用去枕平卧位，头侧向一边，防止呕吐物吸入气管； 二、因术后大多数患者