卵巢良性囊肿剥除不同术式效果比较及阴式途径的特点分析

目的：比较采用阴式途径、腹腔镜以及腹式不同术式行卵巢囊肿剥除术治疗卵巢良性囊肿的临床效果，总结阴式途径术式的特点。方法2006年1月至2012年12月来我院治疗的卵巢良性囊肿患者226例，其中75例行经阴道手术（阴式组），77例行腹腔镜下手术（腹腔镜组），74例行开腹手术（腹式组）。观察比较3组的手术时间、术中出血量、术后镇痛病例、术后排气时间和住院天数，以及术后病率。随访时间为术后1、3个月，进行临床疗效评定。结果术中手术时间和出血量阴式组（41.71±16.92）min、（33.11±20.19）ml]与腹腔镜组（50.73±18.71）min、（38.21±18.73）ml]和腹式组（61.81±19.75）min、（107.29±41.27）ml]相比最少；术后排气时间（12.19±4.17）h 较腹腔镜组（15.43±4.31）h、腹式组（30.00±6.21）h 短；住院时间阴式组（4.38±1.30）d 较腹腔镜组（5.60±0.50）d、腹式组（8.50±2.00）d]短，差异有统计学意义（P ＜0.05或 P ＜0.01）；术后病率阴式组1.33％、腹腔镜组1.30％较腹式组（4.05％）低，差异有统计学意义（P =0.036）。随访到3个月，3组有效率阴式组94.7％（71/75）、腹腔镜组94.8％（73/77）、腹式组94.6％（70/74）]比较差异无统计学意义（P ＞0.05）。结论经阴道手术和腹腔镜手术治疗卵巢良性囊肿各有利弊，临床应用要准确掌握手术指征，以最小的创伤达到最佳治疗效果。

Comparison of different operative approach on benign ovarian removal and the characters of Yin way of operation

Objective To investigate the clinical effect of abdominal operation,laparoscopic operation and vaginal operation on treating ovarian cysts in order to summarize the characteristics of Yin type way operation. Methods Two hundreds and twenty-six patients with benign ovarian cysts were selected as our subjects and they were hospitalized from Jan. 2006 to Dec. 2012 in the First People＆#39;s Hospital of Shangqiu. Of 226 patients,there were 77 cases with laparoscopic operation（ laparoscopic group）,75 cases with vaginal operation（transvaginal group）,and 74 cases with traditional open operation（abdominal group）. The information of operation periods,intraoperative blood loss volum,postoperative analgesia,postoperative exhaust time and hospitalization days,and the rate of postoperative complication were collected. All the patients were followed-up at 1 or 3 months after surgery. Results Operation periods and bleeding volume in vaginal group was（41. 71 ± 16. 92）min and（33. 11 ± 20. 19）ml,less than that in laparoscopic（（50. 73 ± 18. 71）min,（38. 21 ± 18. 73）ml）and abdominal group（（61. 81 ± 19. 75）min.（107. 29 ± 41. 27）ml）and the difference was significant. Meanwhile,gastrointestinal function recovery in vaginal group was（12. 19 ± 4. 17）h,less than that other two groups（15. 43 ± 4. 31）h and（30. 00 ± 6. 21）h）. In addition,shorter hospitalization period was also less than that of other two groups（（4. 38 ± 1. 30）d vs.（5. 60 ± 0. 50）d vs.（8. 50 ± 2. 00）d;P 〈 0. 05 or P〈 0. 01）. The rate of postoperative complication of laparoscopic group was 1. 30% ,and 1. 33% for transvaginal group and 4. 05% for abdominal group,and the difference was significant（ P = 0. 036）. After followed-up 3 months,the clinical effect of transvaginal group was 94. 7% ,94. 8% for laparoscopic group and 94. 6%（70 / 74） for abdominal group,and the difference was not significant（ P 〉 0. 05 ）. Conclusion The approaches of transvaginal operation and laparoscopy operation treating the ovarian cyst have their advantages and disadvantages. It is better to accurately understand the operation indications and then achieve the best therapeutic effect with minimal trauma.