作者：林口長庚醫院・婦科腫瘤及婦癌科主任・副教授級主治醫師 陳威君醫師

達文西機械手臂手術可適用於多項婦科疾病。過去需要開腹才能執行的手術，在達文西機械手臂的輔助下，大切口得以以數個 0.5 至 1 公分的小孔取代，這對病人來說意味著出血少、傷口小、疼痛感減低、復原快。

雖然術後的恢復速度比傳統開腹手術和腹腔鏡手術來得快是無庸置疑，但仍需注意傷口的護理、術後活動與飲食攝取，讓身體充分復原，才不枉達文西機械手臂帶來的好處。

一、術前建議備品

  • 一般、夜用衛生棉數片
  • 免洗內褲
  • 成人尿布墊（看護墊）2 至 4 片
  • 肌膚較敏感者，可自備 1 吋寬的 3M 紙膠帶，方便傷口換藥固定

二、術後照顧

傷口護理

  1. 達文西機械手臂手術如同腹腔鏡手術，術前會先把二氧化碳氣體灌入腹腔內，如同半圓型的氣球，以增加手術空間，使手術時的視野更清晰。因此術後可能會有腹脹、腰痠、背痛、肩痛或肋骨下不適等反射痛。術後若無法忍受，可平躺臥床，並將病床調整為頭低腳高的姿勢，讓腹部的殘餘二氧化碳氣體排出，或是使用暖暖包熱敷兩側肩膀痠痛處。大部分患者症狀會持續幾小時，少數患者會持續幾天，通常這些症狀在術後 48 小時會慢慢緩解。
  2. 達文西手術麻醉會採全身麻醉。術後醒來，可能會有全身無力、頭暈、嘔吐、喉嚨疼痛、口乾、咳嗽、痰多等症狀，都是很常見的反應。大部分患者症狀會持續幾個小時，少數患者會持續幾天後逐漸緩解。
  3. 術後傷口在麻醉作用消退後仍會疼痛，建議採坐臥姿勢，不拉扯腹部傷口，使腹部放鬆，減輕傷口疼痛。建議臥床時每小時翻身一次，進行單腳彎曲伸直運動，改變姿勢以減輕不適；切勿因疼痛而固定姿勢，以免造成血栓靜脈炎。
  4. 術後麻藥退後如無不適，可慢慢的開始下床活動，站姿能促進術後腸胃蠕動。

全身麻醉術後注意事項

全身麻醉術後注意事項說明

三、術後活動

性生活

  1. 保持心情愉快、生活作息規律有助於手術後復原。
  2. 單純的卵巢、輸卵管或沾黏之切除，大約可在術後一個月恢復性生活；如果接受子宮切除者，則約需兩個月。
  3. 肌瘤切除者，手術後 6 個月內應避免懷孕。
  4. 建議經醫師檢查傷口無礙後，再恢復性生活。
  5. 術後一般月經恢復時間為 1 至 2 個月；但手術後 2 至 3 週內可能會有少量出血。

運動

  1. 一個月內避免腿部及骨盆激烈活動，如騎腳踏車、劇烈跳舞、久坐及長時間開車，以免骨盆充血不適。
  2. 避免抱小孩或提 5 公斤以上重物；若無法避免，可適度使用束腹帶支托，以避免震動所引起的疼痛。
  3. 每週固定健走散步，可促進血液循環及消化吸收；後續可依個人體力，漸進式增加活動量。

四、衛生與照護

  1. 每天清洗外陰部，並觀察有無分泌物及其顏色、量、氣味。
  2. 手術一個月內，不可陰道灌洗或使用衛生棉條，避免感染。
  3. 如廁後，由前往後擦拭。

五、飲食攝取

  1. 術後的進食時機應遵循醫囑或護囑。建議進食前先試飲溫開水，20 分鐘後若無不適，即可以少量多餐方式先吃一些白稀飯、麵線等軟性食物，後續再以漸進式方式恢復日常的均衡飲食。
  2. 每天攝取約 1500 至 2500 c.c. 的水分，一個月內避免食用太辣、太鹹等刺激性食物，菸、酒、濃茶及咖啡也須減少。
  3. 多攝取高蛋白食物，以促進傷口復原，如肉、魚、蛋、奶類。可採正常飲食後，多攝取高纖維食物，避免便秘，如蔬菜水果、燕麥、糙米等。
  4. 雙側卵巢切除者，因荷爾蒙分泌變化，易有骨質疏鬆症的發生，飲食中應多增加鈣質攝取，如小魚乾、牛奶、鈣片等。

六、就醫提醒

出現以下情形，請盡快就醫：

  1. 發燒（耳溫或腋溫測量 ≧ 38℃）。
  2. 下腹部不明原因劇烈疼痛。
  3. 陰道有黃色、綠色、惡臭等異常分泌物，或出血量過多的不正常出血。
  4. 傷口紅、腫、熱、痛及出現分泌物。

English Version｜Post-Operative Care After Robotic Gynecologic Surgery

Robotic-assisted surgery can be applied to a wide range of gynecologic conditions. Procedures that previously required open surgery can now be performed through several 0.5 to 1 cm incisions, which means less blood loss, smaller wounds, reduced pain, and faster recovery.

Although recovery is undoubtedly faster than with open or conventional laparoscopic surgery, proper wound care, appropriate activity, and adequate nutrition remain essential for full recovery.

1. Items to Prepare Before Surgery

  • Sanitary pads (regular and overnight)
  • Disposable underwear
  • 2 to 4 adult underpads
  • For sensitive skin: 1-inch paper tape (e.g. 3M) for securing wound dressings

2. Post-Operative Care

Wound Care

  1. As in laparoscopic surgery, carbon dioxide is insufflated into the abdominal cavity before the procedure to create working space and improve visualization. After surgery, you may experience bloating, lower back pain, shoulder pain, or discomfort below the ribs — referred pain caused by residual gas. If uncomfortable, lie flat with the bed adjusted to a slight head-down position to help the residual gas disperse, or apply a warm pack to the shoulders. Most patients experience these symptoms for several hours; in some cases they last a few days, and they usually subside within 48 hours.
  2. Robotic surgery is performed under general anesthesia. Upon waking, you may experience weakness, dizziness, nausea, sore throat, dry mouth, coughing, or increased sputum. These are common reactions that typically resolve within hours, or occasionally over a few days.
  3. Wound pain returns as the anesthesia wears off. A semi-reclined position helps relax the abdomen and reduces tension on the incisions. While in bed, turn over at least once an hour and perform gentle leg flexion and extension exercises. Avoid staying in one position for prolonged periods, as this increases the risk of thrombophlebitis.
  4. Once the anesthesia has worn off and if you feel well, begin walking gradually. Standing and walking help restore bowel motility.

3. Activity After Surgery

Sexual Activity

  1. A positive mood and regular daily routine support recovery.
  2. After simple ovarian, tubal, or adhesion surgery, sexual activity may generally resume about one month after surgery. After hysterectomy, approximately two months is recommended.
  3. Patients who have undergone myomectomy should avoid pregnancy for 6 months after surgery.
  4. Resume sexual activity only after your physician has confirmed that the wound has healed.
  5. Menstruation usually returns within 1 to 2 months. Light bleeding may occur during the first 2 to 3 weeks after surgery.

Exercise

  1. Avoid vigorous leg and pelvic activity for one month, including cycling, intense dancing, prolonged sitting, and long-distance driving, which may cause pelvic congestion.
  2. Avoid lifting children or objects heavier than 5 kg. If unavoidable, an abdominal binder may provide support and reduce pain from movement.
  3. Regular walking each week promotes circulation and digestion. Activity can be increased gradually according to your own tolerance.

4. Hygiene and Care

  1. Clean the perineal area daily and observe any discharge for colour, amount, and odour.
  2. Do not use vaginal douching or tampons for one month after surgery, to avoid infection.
  3. Wipe from front to back after using the toilet.

5. Diet

  1. Follow your physician’s or nurse’s instructions regarding when to resume eating. Start with a sip of warm water; if there is no discomfort after 20 minutes, begin with small, frequent portions of soft foods such as rice porridge or noodles, then gradually return to a normal balanced diet.
  2. Drink approximately 1,500 to 2,500 mL of water daily. Avoid spicy, salty, or irritating foods for one month, and reduce tobacco, alcohol, strong tea, and coffee.
  3. Increase protein intake to support wound healing (meat, fish, eggs, dairy). Once on a normal diet, include high-fibre foods such as vegetables, fruit, oats, and brown rice to prevent constipation.
  4. Patients who have undergone bilateral oophorectomy are at increased risk of osteoporosis due to hormonal changes. Increase calcium intake through foods such as small dried fish, milk, or calcium supplements.

6. When to Seek Medical Attention

Please contact your medical team promptly if any of the following occur:

  1. Fever (ear or axillary temperature ≧ 38℃)
  2. Severe, unexplained lower abdominal pain
  3. Yellow, green, or foul-smelling vaginal discharge, or heavy abnormal bleeding
  4. Wound redness, swelling, warmth, pain, or discharge

婦科腫瘤與子宮內膜癌微創手術評估

  • 陳威君醫師｜婦科腫瘤／婦癌專科・副教授級主治醫師
  • 專長：海扶刀、單孔達文西微創手術、微波消融治療
  • 門診：林口長庚紀念醫院、土城長庚紀念醫院
  • 門診諮詢｜LINE 搜尋：@hifudr