肝硬化失代偿期患者行宫腔镜手术的安全性

目的探讨肝硬化失代偿期患者行宫腔镜手术的安全性与临床效果。方法回顾性分析2012年10月至2018年12月北京佑安医院妇科宫腔镜手术治疗的肝硬化失代偿期患者45例。记录手术时间、术中出血量、术后住院时间、并发症等围手术期指标,监测围手术期的血常规、肝功能及凝血功能等指标,综合评价肝硬化失代偿期患者临床治疗效果。结果45例手术均顺利完成,手术时间为10~205 min,平均(48.82±38.40)min,术中出血量2~100 mL,平均(13.18±35.04)mL、术后住院时间为1~13 d,平均(3.78±3.16)d,术后并发症发生率为13.33%(6/45)。将术前、术后的血常规、凝血功能、肝功能等指标进行比较,其中白蛋白术前为23.8~43.5 g/L,平均(33.95±4.61)g/L,术后为22.9~42.6 g/L,平均(32.04±4.24)g/L;血小板术前30~278×10^9/L,平均(71.84±44.45)×10^9/L,术后21~266×10^9/L,平均(67.58±44.59)×10^9/L,术后均较术前显著下降,差异有统计学意义(P<0.05)。结论在严格把握手术指征、正确充分的围手术处理,熟练掌握宫腔镜手术技巧,注重止血,预防感染的前提下,肝硬化失代偿期患者行宫腔镜手术是安全可行的。

Clinical observation of hysteroscopic surgery in patients with decompensated liver cirrhosis

Objective To investigate the safety and efficacy of hysteroscopic surgery in patients with decompensated liver cirrhosis.Methods The clinical data of hysteroscopic operations in patients with decompensated liver cirrhosis from October 2012 to November 2018 in our hospital were retrospectively analyzed.Perioperative indicators including operation time,intraoperative blood loss,postoperative hospitalization time and complications were recorded.Moreover,the laboratory examination including blood routine,liver function,biochemistry and coagulation function were monitored and compared before and after the operation.Results The operations were completed successfully in all the 45 patients.The mean operation time was(48.82±38.40)minutes(ranged from 10 to 205 minutes).The mean intraoperative blood loss was(13.18±35.04)ml(ranged from 2 to 100 ml).And the mean time of postoperative hospitalization was(3.78±3.16)days(ranged from 1 to 13 days).The incidence of postoperative complications was 13.33%(6/45).The albumin level and platelet count were significantly lower postoperative than those preoperative(32.04±4.24)g/L vs.(33.95±4.61)g/L,(67.58±44.59)×10^9/L vs.(71.84±44.45)×10^9/L,P<0.05].Conclusion It is safe and feasible for patients with decompensated liver cirrhosis to undergo hysteroscopic surgery on the basis of strict surgical indication,appropriate perioperative management,practiced hysteroscopic surgery skills,as well as emphasis on hemostasis and infection prevention.