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中华腔镜外科杂志(电子版)

中华腔镜外科杂志(电子版) ›› 2016, Vol. 09 ›› Issue (03): 168 -171. doi: 10.3877/cma.j.issn.1674-6899.2016.03.011

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改良腹腔镜辅助阴式切除巨大子宫临床疗效探究
常蕊 1, 刘阳 1, 冯彩霞 1, 刘尚华 1, 王楠 1, 高燕云 1 , †( )   
  1. 1. 719000 榆林，陕西省榆林市第一医院妇产科
  • 收稿日期:2016-04-19 出版日期:2016-06-30
  • 通信作者: 高燕云

Clinical effect of improved laparoscopic assisted vaginal hysterectomy for the removal of large uterus

Rui Chang 1, Yang Liu 1, Caixia Feng 1, Shanghua Liu 1, Nan Wang 1, Yanyun Gao 1 , †( )   

  1. 1. Department of Obstetrics and Gynecology, Yulin First Hospital of Shanxi Province, Yulin City, Yulin 719000, China
  • Received:2016-04-19 Published:2016-06-30
  • Corresponding author: Yanyun Gao
  • About author:
    Corresponding author: Gao Yanyun. Email:
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目的

评估改良腹腔镜辅助阴式子宫切除术(LAVH)切除巨大子宫的临床疗效，探讨其价值和意义。

方法

回顾性分析180例接受LAVH患者的临床资料，平均年龄(49.4±8.5)岁，分为观察组(子宫体积 ≥ 12孕周)和对照组(子宫体积 < 12孕周)，比较两组的一般资料、手术时间、术中出血量、输血率、平均住院时间、并发症发生率、中转开腹率等指标。

结果

两组的平均年龄、体质量指数符合正态分布且差异无统计学意义；观察组子宫体积较对照组大[(15.4±3.6)孕周 vs (7.6±2.2)孕周]，两组疾病构成亦有区异 (P<0.001)；观察组的平均手术时间[(83.9±32.9)min vs(50.6±20.8)min(P<0.001)]、术中出血量[(259.4±122.6)ml vs (150.9±95.1)ml(P<0.001)]和输血率[8例(10.3%)vs 2例(2.0%)(P＝0.016)]均多于对照组，差异有统计学意义；两组手术并发症发生率、平均住院时间和中转开腹率差异无统计学意义。

结论

改良LAVH切除巨大子宫是安全、可靠的，尽管观察组术中出血量和手术时间高于对照组，但并不增加手术并发症发生率和平均住院时间，需注意适应证的选择和术者手术技巧的掌握。

关键词: 腹腔镜辅助阴式子宫切除术, 改良术式, 巨大子宫, 并发症
Objective

To evaluate the clinical effect of the improved laparoscopic assisted vaginal hysterectomy for the removal of huge uterine and to explore its value and significance.

Methods

The clinical data of 180 patients undergoing laparoscopic assisted vaginal hysterectomy were analyzed retrospectively. Average age(49.4±8.5) years old. All patients were divided into observation group (uterine ≥ 12 weeks) and control group (uterus< 12 weeks). Indicators were compared with the two groups of cases of general information, operation time, blood loss, blood transfusion rate, average hospitalization days, incidence of complications, and conversion rate.

Results

There were no statistically significant differences between the two groups in terms of age and BMI. The uterine size of the observation group was larger than that of the control group[(15.4±3.6)weeks vs (7.6±2.2)weeks], and there were also differences in disease constitute between two groups (P<0.001). In the observation group, the average operation time[(83.9±32.9)min vs (50.6±20.8)min(P<0.001)], intraoperative blood loss[(259.4±122.6)ml vs (150.9±95.1)ml (P<0.001)] and blood transfusion rate[8(10.3%)vs 2(2.0%)(P=0.016)] were more than those in the control group, the difference was statistically significant. There was no significant difference between the two groups in the incidence of surgical complications, the average hospitalization days and the rate of conversion to laparotomy.

Conclusions

The improved laparoscopic assisted vaginal hysterectomy for the removal of the uterus is safe and reliable. Although the amount of intraoperative bleeding and operation time in the observation group was higher than the control group, but the incidence of surgical complications and the average hospitalization days did not increase. Following strict operation indications and operation technique are the keys to get the best result.

Key words: Laparoscopic assisted vaginal hysterectomy, Improved operation method, Large uterine, Complication
表1 腹腔镜辅助阴式子宫切除患者的两组临床特征比较
项目 观察组(78例) 对照组(102例) P值
平均年龄(岁) 48.9±7.7 49.8±9.3 0.393
体质量指数(kg/m2) 25.8±4.0 26.6±3.8 0.283
子宫大小(孕周) 15.4±3.6 7.6±2.2 <0.001
疾病构成[例数(%)] ? ? <0.001
? 子宫肌瘤 36(46.2) 17(16.7) <0.001
? 月经量过多/不规则出血 10(12.8) 21(20.6) 0.171
? 慢性盆腔痛 5(6.4) 8(7.8) 0.713
? 子宫腺肌症 17(21.8) 9(8.8) 0.014
? 宫颈上皮内瘤变 3(3.8) 28(27.5) <0.001
? 绝经后阴道流血 4(5.1) 12(11.8) 0.127
? 子宫内膜病变 3(3.8) 7(6.9) 0.381
表2 腹腔镜辅助阴式子宫切除患者的两组手术指标比较
项目 观察组(78例) 对照组(102例) P值
平均手术时间(min) 83.9±32.9 50.6±20.8 <0.001
术中出血量(ml) 259.4±122.6 150.9±95.1 <0.001
输血率[例数(%)] 8(10.3) 2(2.0) 0.016
平均住院时间(d) 8.9 ±3.4 6.8±2.3 0.260
并发症发生[例数(%)] 9(11.5) 8(7.8) 0.401
中转开腹[例数(%)] 2(2.6) 2(2.0) 0.786
表3 腹腔镜辅助阴式子宫切除患者的两组手术并发症比较(例数)
并发症 观察组(78例) 对照组(102例)
膀胱损伤 2 1
发热 2 2
输尿管损伤 1 0
大血管损伤 1 0
阴道残端血肿/感染 1 2
泌尿系统感染 1 1
肠梗阻 1 1
肠道损伤 0 1
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