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首页> 外文期刊>Journal of minimally invasive gynecology >A technique to deal with severe adhesions between the uterus and bladder or rectum in laparoscopic-assisted vaginal hysterectomy.
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A technique to deal with severe adhesions between the uterus and bladder or rectum in laparoscopic-assisted vaginal hysterectomy.

机译：一种在腹腔镜辅助阴道子宫切除术中处理子宫与膀胱或直肠之间严重粘连的技术。

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摘要

Severe adhesions between uterus and bladder or rectum, especially caused by endometriosis and multiple cesarean sections, remain a great challenge to surgeons in laparoscopic-assisted vaginal hysterectomy. Dense adhesions and anatomic variations cause difficulty in dissecting tissue planes, significant bleeding, lengthy operative time, and visceral injuries, especially an unrecognized thermal injury leading to late-onset fistulae or abscess. A modified technique, the combination of vaginal and laparoscopic approach with assistance of a Deaver retractor, is introduced in this article, which can achieve several advantages, including easily and safely dissecting tissue planes as close to the edge of adhesions as possible, avoidance of bladder or rectum injuries, less bleeding, shortened operative time, and minimized possibility of conversion to exploratory laparotomy if the surgeon is experienced in this technique.
机译：子宫与膀胱或直肠之间的严重粘连，尤其是由子宫内膜异位症和多处剖宫产引起的粘连，仍然是外科医师在腹腔镜辅助阴道子宫切除术中面临的巨大挑战。密集的粘连和解剖学变化导致难以解剖组织平面，大量出血，较长的手术时间和内脏损伤，尤其是无法识别的热损伤，导致迟发性瘘管或脓肿。本文介绍了一种改良的技术，将阴道和腹腔镜方法与Deaver牵开器相结合，可实现多种优势，包括轻松安全地解剖组织平面，使其尽可能靠近粘连边缘，避免膀胱或直肠损伤，出血少，手术时间缩短，并且如果外科医生有此技术经验，则将其转换为探索性剖腹手术的可能性降至最低。

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