腹腔镜全子宫切除术后阴道残端的处理体会

目的:探讨腹腔镜全子宫切除术后阴道残端的处理方法。方法:随机将2009年5月至2012年2月267例腹腔镜全子宫切除术患者分为两组,对照组(n=132)经阴道行连续锁边缝合;研究组(n=135)经腹腔行连续锁边缝合,比较两组患者术中阴道流血量、阴道残端处理时间、术后阴道流血量及阴道流血时间、住院时间、术后并发症及随访情况。结果:两组术中、术后阴道流血量及流血时间、术后并发症、术后3个月内阴道排液量差异有统计学意义(P<0.01),而处理时间、住院时间差异无统计学意义(P>0.05)。结论:两种方法均适用于腹腔镜全子宫切除术,但经腹腔行连续锁边缝合具有术中、术后阴道流血量少、时间短、术后并发症少等优点,更利于妇科微创手术的临床推广。

The treating of vaginal stump after laparoscopic total hysterectomy

Objective：To discuss the treating of vaginal stump after laparoscopic total hysterectomy. Methods：Two hundred and sixty-seven patients who had laparoscopic total hysterectomy due to gynecological diseases from May 2009 to Feb. 2012 were ran-domly divided into control group and study group,the control group included 132 patients who were treated with transvaginal continuous suture;the study group included 135 cases who were treated by transabdominal continuous suture. Then, the amount of vaginal bleeding, the time of vaginal stump processing, the amount and time of vaginal bleeding after operation, the average hospital stay, postoperative complications and follow-up situation were compared between the two groups of patients. Results： The intraoperative and postoperative a- mount and time of vaginal bleeding, postoperative complications, vaginal discharge in 3 months after surgery of control group were signif- icantly different with study group （P 〈 0.01 ）, the difference of the time of vaginal stump processing and the average hospital stay was not statistically significant （P 〉 0.05 ）. Conclusions： The two kinds of methods are both suitable for laparoscopic total hysterectomy, while the transabdominal continuous suture has advantages of the less amount and the shorter time of intraoperative and postoperative vaginal bleeding and fewer postoperative complications, which are favorable for carrying on gynecologic minimally invasive surgery.