改进腹腔镜与开腹大子宫全切术的比较

目的 探讨双极联合超声刀腹腔镜下大子宫全切除术的安全性和可行性.方法 2009年2月～2012年7月145例因子宫良性病变行大子宫(子宫12～ 20孕周大小)切除术,按患者意愿分为腹腔镜组(n=78)和开腹组(n=67),比较2组患者手术情况、术后恢复、住院时间、并发症及随访情况.结果 腹腔镜组术中出血少(102.7 ±35.6)ml vs.(125.4±23.7)ml,t=-4.441,P=0.000],术后肠道恢复快(45.6±6.8)h vs.(67.4±8.5)h,t=-17.149,P=0.000],住院时间短(5.5±0.5)d vs.(7.7±0.6)d,t=-24.083,P=0.000],切口非甲级愈合率低0 vs.7.5％ (5/67),P=0.019].2组并发症发生率比较无统计学差异2.6％ (2/78) vs.4.5％(3/67),x2=0.030,P=0.863].腹腔镜组随访74例,随访时间5～32个月,(28.7±6.2)月,术后1～3个月左下腹最大穿刺孔轻微疼痛2例,3个月后无不适;开腹组随访64例,随访时间5～ 36个月,(30.5±5.8)月,术后1～6个月腹部切口疼痛4例,6个月后无不适.结论 腹腔镜下大子宫全切术是安全、可行的,较开腹手术具有出血少、恢复快、住院时间短的优势.

Comparison of Modified Total Laparoscopic Hysterectomy with Abdominal Hysterectomy for Large Uterus

Objective To explore the safety and the feasibility of laparoscopic hysterectomy for large uterus using bipolar combined with ultrasonic scalpel.Methods 145 patients who underwent laparoscopic hysterectomy due to gynecological benign lesions（the uterus approximately 12-20 gestational weeks in size）from February 2009 to July 2012 were divided into laparoscopic group（n=78） and open group（n=67）.The operation situation,postoperative recovery,hospital stay,postoperative complications and follow-up situation were compared between the two groups.Results Compared with the open group,the laparoscopic group had less blood loss（102.7±35.6） ml vs.（125.4±23.7） ml,t=-4.441,P=0.000],faster bowel function recovery time（45.6±6.8） h vs.（67.4±8.5） h,t=-17.149,P=0.000],shorter hospital stay（5.5±0.5） d vs.（7.7±0.6） d,t=-24.083,P=0.000],and lower incision non healing rate 0 vs.7.5%（5/67）,P=0.019].There was no statistical difference in the complication rate between the two groups 2.6%（2/78） vs.4.5%（3/67）,χ^2=0.030,P=0.863].Seventy four cases in the laparoscopic group were followed up for 5 to 32 months,with an average of（28.7±6.2） months,and 2 cases had mild pain in the largest puncture of left lower abdomen 1 to 3 months after operation and recovered 3 months later.Sixty four cases in the open group were followed up for 5 to 36 months,with an average of（30.5±5.8） months,during which abdomen incision pain was found in 4 cases 1 to 6 months after operation and recovered 6 months later.Conclusion Laparoscopic hysterectomy for large uterus using bipolar combined with ultrasonic scalpel is safe and feasible,with the advantages of less blood loss,faster bowel function recovery,shorter hospital stay as compared with open surgery.