微创手术在妇产科的运用.pdf

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1、微創手術在婦產科的運用Introduction•1807Bozzini:acandlelightconductor•1880Nitzedevelopedthecystoscope•1901Kelling:celioscopeexaminationofalivingdogafterpneumoperitoneum•1901Jacobaeus:laparoscopybydirectinsertionofaNitzecystoscope•1938Veress:anewneedleforinducingpneumothoraxforthetreatm

2、entofTBforpneumoperitoneum.Introduction•1937thefirstgynecologicreportwaspublishedbyHopeontheuseofthelaparoscopefordiagnosisoftubalpregnancy•1941PowerandBarnes:fortubalsterilization•1952:coldlightHistory•1952:Fiberoptics•1972AmericanAssociationofGynecologicLparoscopistswasfo

3、rmed1987-1992residentsshoulddocumenttheirtrainingingynecologicendoscopicprocedure.Introduction•1973年台大醫學院黃國恩教授使用內生殖鏡輸卵管節育法替病人結紮。•1975年馬偕醫院蔡明賢醫師使用開放式腹腔鏡術做診斷。•1977年中興醫院林水盛、張中全做子宮外孕的腹腔鏡診斷，減少錯誤診斷及不必要的剖腹手術。•真正開始手術性腹腔鏡是由劉宗元、歐朝士兩位教授於1991至1993年前後六次回國教授內視鏡手術Benefit•Reduceperitonealt

4、rauma•Reducecontaminationoftheperitonealcavity•Lessadhesion•Shortenedstay•SmallwoundPotentiallimitation•Operativefieldcanbereduced•Difficultsuture•Prolongedoperatingroomtime•Moreexpensivesurgicalequipment•Surgicalexpertise•Withanadequatecombinationofability,trainingandexper

5、ience,operativetimeandcomplicationsarecomparabletothoseoftraditionalabdominalsurgeryWHOsuggest•Sterilization•Ectopicsurgery•DiagnosticTubalsurgery•Sterilization:•Since1960s•Suture,clips,silasticrings•Electrosurgicaldesiccationwithbipolarenergy•Failurerate:5.4/1000Ectopicpre

6、gnancy•Laparoscopicsalpingostomy,•Laparoscopicsalpingectomy•LaparoscopicsegmentalresectionofaportionoftheoviductOvariansurgery•Ovarianmasses:•Removaloftheselectedovarianmasses•Preoperativeultrasonography•Sonolucent,thinwall,nosolidcomponents•CA125•Matureteratoma•Ovariantors

7、ion•ThroughlaparoscopiccannulaandposteriorcolostomyUseretrievalbagEndomtriosis•Recentfinding:•Large,longterm,prospectivestudieandplacebocontrolled,randomized,controlledtrialsuggestlaparoscopicexcisionisaneffectivetreatmentapproachforpatientswithallstagesofendomtriosis.Uteri

8、nesurgery•Hyeterectomy•Totallaparoscopichysterectomy(TLH)•Subtotallaparoscopichyst