不同体质指数患者行腹腔镜全子宫切除术的近期临床疗效分析

目的：探讨不同体质指数（body mass index,BMI）的患者行腹腔镜全子宫切除术（total laparoscopic hysterectomy,TLH）的临床治疗效果。方法：回顾分析为244例患者行TLH的临床资料。将患者分为理想、超重和肥胖3组,体重过轻的患者并入理想组。理想组128例（52.5%）,BMI范围17.7~23.9kg/m2;超重组66例（27.0%）,BMI 24.1~27.9kg/m2;肥胖组50例（20.5%）,BMI 28~38.2kg/m2。观察各组病例近期临床治疗效果。结果：理想、超重和肥胖组平均手术时间分别为（81.3±25.5）min、（89.5±27.8）min和（90.7±26.0）min,理想组的手术时间短于其他两组（P〈0.05）,超重组和肥胖组的手术时间差异无统计学意义（P〉0.05）。估计术中出血量分别为（41.8±21.3）ml、（47.4±22.7）ml和（47.0±32.8）ml;手术前后血红蛋白含量变化分别为（-6.8±8.4）g/L、（-6.4±8.2）g/L和（-4.4±7.7）g/L;术后肛门排气时间分别为（1.8±0.7）d、（1.9±0.7）d和（1.9±0.7）d;术后平均住院时间分别为（8.3±1.7）d、（8.4±1.3）d和（8.6±1.7）d;术后平均体温第1天分别为（37.0±0.3）℃、（37.0±0.4）℃和（36.9±0.3）℃,第2天分别为（36.8±0.3）℃、（36.9±0.3）℃和（36.8±0.3）℃,第3天分别为（36.7±0.2）℃、（36.7±0.3）℃和（36.7±0.2）℃,3组之间差异无统计学意义（P〉0.05）。3组总并发症发生率为2%,理想组术中膀胱损伤2例（0.8%）;超重组术后感染3例,包括不明原因的发热2例（0.8%）,上呼吸道感染1例（0.4%）。结论：BMI对TLH的近期临床疗效影响较小。需要全子宫切除的肥胖患者行TLH安全有效,严格掌握腹腔镜的手术适应证,部分肥胖患者可将TLH作为全子宫切除术的新选择。

The short-term clinical therapeutic effect analysis of total laparoscopic hysterectomy for patients with different body mass index

Objective:To investigate the clinical therapeutic effect of total laparoscopic hysterectomy(TLH) for patients with different body mass index(BMI).Methods:The clinical data of 244 patients who underwent TLH were retrospectively analyzed.All cases were divided into 3 groups:ideal group,overweight group and obese group,underweight patients were enrolled in ideal group.128(52.5%) patients were in ideal group,with BMI 17.7-23.9kg/m2;66(27.0%) patients were in overweight group,with BMI 24.1-27.9kg/m2;50(20.5%) patients were in obese group with BMI 28-38.2kg/m2.The short-term clinical therapeutic effect of each group was observed.Results:The statistically significant difference of ideal,overweight and obese group was found only in mean operative time (81.3±25.5)min,(89.5±27.8)min and(90.7±26.0)min,respectively,P<0.05].The operative time of ideal group was shorter than overweight and obese groups(P<0.05).However,there were no difference in operative time between overweight and obese group(P>0.05).Blood loss (41.8±21.3)ml,(47.4±22.7)ml and(47.0±32.8)ml respectively],changes of hemoglobin content(-6.8±8.4)g/L,(-6.4±8.2)g/L and(-4.4±7.7)g/L respectively],anus exhaust time(1.8±0.7)d,(1.9±0.7)d and(1.9±0.7)d respectively)] and mean postoperative hospital stay (8.3±1.7)d,(8.4±1.3)d and(8.6±1.7)d respectively)] did not vary among 3 groups(P>0.05).In addition,the average body temperature was(37.0±0.3)℃,(37.0±0.4)℃ and(36.9±0.3)℃ during first day postoperatively,and the average temperature of the second day were(36.8±0.3)℃,(36.9±0.3)℃,(36.8±0.3)℃ and the third day were(36.7±0.2)℃,(36.7±0.3)℃,(36.7±0.2)℃.There were no statistically significant difference among 3 groups(P>0.05).Total complication rate was 2%.2 cases of bladder injury(0.8%) were found in ideal group;3 cases of postoperative infection occurred in overweight group,including 2 cases(0.8%) of fever with unknown reason and 1 case(0.4%) of upper respiratory tract infection.Conclusions:BMI dose not has significant effect on short-term clinical therapeutic effect of TLH.For obese patients who should receive total hysterectomy,TLH is safe and effective.When indications of laparoscopic operation are strictly grasped,TLH can be a new alternative of traditional total hysterectomy for some obese patients.