残端宫颈切除术30例临床分析

　　【摘要】目的 探讨子宫次全切除术的手术指征及残端宫颈切除术并发症的预防。方法 回顾性分析子宫次全切除术后再次来我院行残端宫颈切除术的30例患者的临床资料。结果 30例子宫次全切除术患者有25例因年轻要求保留宫颈，5例在外院手术时因手术困难而保留宫颈。残端宫颈切除的病因为宫颈上皮内瘤样病变(5例)、宫颈癌(1例)、宫颈肌瘤(5例)、宫颈子宫内膜异位症(2例)，盆腔手术一并切除残端宫颈者17例。结论 45岁以上若为多发性子宫肌瘤或子宫内膜异位症的患者以行子宫全切除术为宜，术前、术中不漏诊子宫、宫颈恶性肿瘤。残端宫颈切除术的要点在于分离粘连，游离输尿管、膀胱, 避免损伤。

　　【关键词】 残端宫颈切除术 子宫次全切除术 损伤

　　Clinical analysis of 30 cases with removal of the retained cervical stump

　　QIAN Xiaoping

　　(Department of Obstetrics and Gynecology, Changzhou Second People′s Hospital Affiliated to

　　Nanjing Medical University, Changzhou, Jiangsu 213003, China)

　　Abstract: Objective To investigate the indications of subtotal hysterectomy and the prevention of the complications form the removal of cervical stump. Methods 30 patients who underwent the removal of the cervical stump subsequent to subtotal hysterectomy were included in the study. Results 25 patients had cervix reserved due to their young age. 5 patients had cervix reserved because of difficulty in operation. Of 30 cases who had their cervical stump removed or retained, 5 cases were due to cervical intraepithelial neoplasia; 1 case due to cervical cancer; 5 cases due to cervical myoma; 2 cases due to cervical endometriosis, and 17 case due to pelvic disease. Conclusions Total hysterectomy is preferable in patients who are over 45 years of age and diagnosed as having multiple myoma or endometriosis. Malignant cervical and endometrial diseases should be excluded before and during total hysterectomy. During the removal of cervical stump, attention should be focused on separation of pelvic adhesions, dissociation of ureters and the bladder and prevention of injury.

　　Key words: removal of cervical stump; subtotal hysterectomy; injury

　　子宫次全切除术是妇产科较常用、最基本的手术方案之一。但术后发生的宫颈病变，如宫颈肌瘤、宫颈子宫内膜异位症、宫颈残端癌、宫颈癌前病变等需再次手术。另外，一些术后发生盆腔包块需再次手术且合并宫颈慢性炎症、不愿行物理治疗的患者要求同时切除宫颈。通过回顾性分析30例残端宫颈切除术患者的临床资料，探讨子宫次全切除术的手术指征，术前、术后的注意事项及残端宫颈切除术并发症的预防。

　　1 临床资料

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