上海市10年妇科腹腔镜手术发展状况

目的 回顾性分析上海市7所医院1990年-1999年间腹腔镜手术资料,总结上海市妇产科腹腔镜手术10年的发展状况和发展趋势,探讨腹腔镜手术在妇科临床中应用前景。方法 以发卷询问形式对上海市开展腹腔镜手术医院的手术例数、手术适应证、手术范围及腹腔镜手术并发症进行调查。结果5所三级医院、2所区级医院给予了回答,回信率 70％。腹腔镜手术总例数9210例,其中5240例诊断性腹腔镜手术,3970例手术性腹腔镜手术。1990年～1997年间,诊断性腹腔镜手术呈平台走势,每年600例左右,1998年、1999年手术性腹腔镜明显增多,而诊断性腹腔镜明显减少。10年间腹腔镜手术的发展分为1990年-1994年和1995年～1999年两个阶段,两个阶段诊断性腹腔镜与手术性腹腔镜比例分别是3.8:1及1:4。所占妇科手术比例从1992年腹腔镜手术开始时的2.31％增加到1999年的30％。手术范围从输卵管切除、附件切除、全子宫切除到盆腔淋巴结切除。并发症89例,发生率0.97％。自1997年后,诊断性腹腔镜并发症几乎降为0,手术性并发症呈下降趋势,1999年手术性腹腔镜1290例中并发症仅6例,发生率0.47%(P<0.01)。结论 手术性腹腔镜手术有替代妇科大部分手术的趋势,并发症发生率随手术性腹腔镜技术的成熟呈下降趋势。

Ten years progress of laparoscopic gynecologic surgery in Shanghai

Objective A retrospective review of laparoscopic surgery of seven hospitals in Shanghai from 1990 to 1999 was analysed and the development and tendency of laparoscopic surgery in the past ten years were discussed so as to understand its possibility of application in gynecology. Methods Letters were sent to the hospitals which have performed operative laparoscopy to survey the number of cases, indications, field of operations as well as the complications. 70% of the hospitals responsed, of which five were affiliated hospitals and two district hospitals. Results The total number of cases was 9 210, of which, 5 240 were diagnostic laparoscopies and 3 970 were operative ones. There were about 600 cases of diagnostic laparoscopy each year from 1990 to 1997. The number of therapeutic laparoscopic surgery increased prominently and the cases of diagnostic surgery decreased obviously during the two years of 1998 and 1999. We divided the ten years into two periods, the beginning period was from 1990 to 1994 and the developing period was from 1995 to 1999. The ratio of diagnostic surgery to the therapeutic surgery was 3.8:1 and 1:4 during the two periods, respectively. The percentage of laparoscopic surgery in gynecological surgery rose from 2.31 % in 1992 to 30% in 1999. The types of surgery included salpingectomy, adenexectomy, hysterectomy and pelvic lymphadenectomy. The incidence of complications was 89/9120 (0.96% ). Since 1997 the complication of diagnostic surgery reduced to nearly zero. There were only 6 complications within the 1 290 therapeutic laparoscopies in 1999 while the incidence was 0.47% ( P < 0.01). Conclusions Therapeutic laparoscopy would replace most of the traditional gynecological surgery and the incidence of complications would decrease with the improvement of the surgical skills.