大子宫全切除术3种术式的临床比较

目的探讨腹腔镜下改良大子宫切除术的临床可行性、安全性及临床效果。方法回顾性分析2011年12月至2015年8月在江阴市人民医院妇科进行大子宫切除术的临床资料174例,将其随机分为3组,其中86例行开腹手术为A组,50例行腹腔镜下常规大子宫切除术为B组,38例行腹腔镜下改良大子宫切除术为C组。比较3组的手术时间、术中出血量、术后肛门排气时间、住院时间、术后病率、中转开腹率、手术并发症的发生率。结果 B组手术时间、术中出血量均高于A组及C组,差异均有统计学意义(K=103.740,P=0.000;K=108.375,P=0.000);A组肛门排气时间、住院时间均长于B组、C组,差异均有统计学意义(K=114.054,P=0.000;K=124.152,P=0.000),而B组与C组之间差异无统计学意义(Z=-1.620,P=0.105;Z=-1.089,P=0.276);A组术后病率高于B组及C组,但3组术后病率比较差异无统计学意义(x^2=4.344,P=0.114);A组、C组手术全部成功,无中转开腹,无输尿管损伤等并发症发生,而B组中转开腹率为12.00%(6/50),并发症发生率为6.00%(3/50)。结论腹腔镜下改良大子宫切除术手术时间短,术中出血量少,中转开腹率少,术后肛门排气时间及住院时间短,术后病率、手术并发症低,值得临床推广应用。

Clinical comparison of three kinds of surgical procedures for total hysterectomy

Objective To investigate the clinical feasibility, safety and clinical effect of improved laparoscopic large uterus hysterectomies. Methods Retrospective analysis was conducted on 174 cases of large uterus hysterectomies during the period of December 2011 to August 2015 in department of gynecology of Jiangyin People's Hospital.They were divided into three groups randomly, among which 86 cases with open surgery in group A, 50 cases with conventional large uterus hysterectomy in group B, and 38 cases with improved laparoscopic large uterus hysterectomies in group C.Three groups were compared in terms of operation duration, intraoperative blood loss, postoperative anal exhaust time, hospitalization length, postoperative morbidity, conversion to open surgery rate, incidence of surgical complications.Results The operation duration and intraoperative blood loss of group B were longer and more than those of group A and group C, and the differences were statistically significant (K=103.740, P=0.000;K=108.375, P=0.000).The anal exhaust time and hospitalization length of group A were longer than those of group B and group C with significant differences (K=114.054, P=0.000;K=124.152, P=0.000), but there was no significant difference between group B and group C (Z=-1.620, P=0.105;Z=-1.089, P=0.276).The postoperative morbidity of group A was higher than that of group B and group C, but the difference was not statistically significant (χ2 =4.344,P=0.114) .Group A and group C were operated successfully with no conversion to open surgery or complications such as ureteral injury, while laparotomy rate in group B was 12.00% (6/50) and the incidence of complications was 6.00% (3/50).Conclusion Improved laparoscopic large uterus hysterectomies has the advantages of shorter operation duration, less intraoperative bleeding, less open surgery rate, shorter postoperative anal exhaust time and hospitalization length, low postoperative morbidity and complications.So it is worthy of clinical popularization and application.