Application of upgraded laparoscopical-assisted vaginal hysterectomy in treating deep and infiltrating type endometriosis in posterior part of pelvic cavity combined with adenomyosis

Objective To explore curative effects and operation techniques of upgraded laparoscopical-assisted vaginal hysterectomy (LAVH) in treating deep and infiltrating type endometriosis in posterior part of pelvic cavity combined with adenomyosis.Methods Eighteen patients with deep and infiltrating type endometriosis in posterior part of pelvic cavity combined with adenomyosis were operated with upgraded LAVH, mutilating round ligament of uterus, ligament ovarii proprium, fallopian tube and uterus blood vessel; bluntly dissecting uterus-rectum crevice to pykno-adherence position with laparoscope and then turning to vaginal operation. After cutting open the vaginal mucosa, we separated crevice between cervix uteri and vagina to abdominal cavity,mutilated uterosacral ligament and cardinal ligament, blated cervix uteri at cervical ligament level and uterine body at adherence position between uterus and rectum, turned out the remained uterus body from ante-fornix of vagina, exposed adherence between uterus posterior wall and rectum, sheared posterior wall of uterus, separated and ablated uterus body adhering to rectum and cut ectopic focus guiding by intrarectal examination.Results Eighteen operations were all accomplished according to reservation method. Two patients with tunica muscularis recti ectopic focus didn't recover because they rejected to ablate intestinal canal. For the 18 patients, the operation time was(144±42)min, the operative blood loss was(155±86)ml and there was no rectum, bladder and ureteral injury. During the 12-36 months follow-up, 16 patients who were cut focus of infection got eusemia. The symptoms of 2 patients who were not cut focus of infection completely got relieved but still had focus of infection.Conclusion This method of turning out uterus body from ante-fornix of vagina, exposing adherence between uterus posterior wall and rectum, separating and ablating ectopic focus and adherence uterine from rectovaginal septum euthyphorialy which improves the operation safety is worth applying for the patients with deep and infiltrating type endometriosis in posterior part of pelvic cavity.