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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 (06): 358 -361. doi: 10.3877/cma.j.issn.1674-6899.2016.06.011

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腹腔镜全子宫切除术中结扎束血管闭合系统的应用研究
边立华 1, 王楠 1, 范文生 1, 叶明侠 1, 王敏 1, 孟元光 1 , †( )   
  1. 1. 100853 北京，解放军总医院妇产科
  • 收稿日期:2016-09-06 出版日期:2016-12-30
  • 通信作者: 孟元光
  • 基金资助:
    国家自然科学基金(81571411)

Application of ligasure vessel sealing system in laparoscopic total hysterectomy

Lihua Bian 1, Nan Wang 1, Wensheng Fan 1, Mingxia Ye 1, Min Wang 1, Yuanguang Meng 1 , †( )   

  1. 1. Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing 100853, China
  • Received:2016-09-06 Published:2016-12-30
  • Corresponding author: Yuanguang Meng
  • About author:
    Corresponding author: Meng Yuanguang, Email:
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目的

评估结扎束血管闭合系统(LF1537 Blunt Tip)在腹腔镜全子宫切除术中应用的临床疗效，探讨其临床价值。

方法

选取解放军总医院2014年1月至2016年1月期间收治并行腹腔镜全子宫切除术患者，根据术中是否使用结扎束血管闭合系统分为观察组(使用结扎束血管闭合系统)和对照组(常规手术)，记录并比较两组的一般资料和手术相关指标。

结果

两组的年龄、体质量指数、腹部手术史符合正态分布且差异无统计学意义(P＝0.625、0.287、0.664)；两组的疾病构成差异无统计学意义(P＝0.808)。观察组的手术时间[(46.6 ± 19.1)min vs (65.8 ± 29.2)min]和术中出血量[(51.0 ± 21.9)ml vs (118.4 ± 50.7)ml]均少于对照组，差异有统计学意义(P< 0.001)；两组的输血(2例 vs 6例)、住院时间[(6.3 ± 2.2)d vs (6.7 ± 2.8) d]、中转开腹(0例 vs 2例)、并发症发生(4例 vs 7例)比较，差异无统计学意义(P＝0.204、0.391、0.182、0.472)。

结论

本研究中将结扎束血管闭合系统(LF1537 Blunt Tip)应用于腹腔镜全子宫切除术，能够更加安全有效的对血管和组织进行闭合和切割，缩短了手术时间，减少了出血量，使手术更加可靠、快捷，具有重要临床应用价值。

关键词: 腹腔镜全子宫切除术, 结扎束, 血管闭合系统, 能量器械
Objective

To evaluate the clinical effect of Ligasure Vessel Sealing System (LF1537 Blunt Tip) in laparoscopic total hysterectomy and to explore its clinical value.

Methods

All patients selected in our hospital during the period of Jan. 2014 to Jan. 2016 undergoing laparoscopic total hysterectomy were analyzed. All cases were divided into observation group (using ligasure group) and control group (conventional surgery group). The general information and the operation related index were compared between the two groups.

Results

The mean age, BMI, history of previous abdominal surgery in the two groups were in the normal distribution and the difference was not statistically significant (P=0.625, 0.287, 0.664). The difference of disease constitute of the two groups was not statistically significant (P=0.808). In the observation group, the average operation time [(46.6 ± 19.1) min vs (65.8 ± 29.2) min]and the blood loss [(51.0 ± 21.9) ml vs (118.4 ± 50.7)ml] during operation were lower than that in the control group. There were no significant difference in the rate of blood transfusion (2 cases vs 6 cases), average length of stay [(6.3 ± 2.2)d vs (6.7 ± 2.8) d], rate of conversion to laparotomy (0 case vs 2 cases), and the incidence of complications (4 cases vs 7 cases) between the two groups (P=0.204, 0.391, 0.182, 0.472).

Conclusions

In this study, Blunt Tip LF1537 was used in laparoscopic total hysterectomy. It can be more safe and effective for the vascular and tissue closure and cutting, shorten the operation time, reduce the amount of bleeding, so that the operation is more reliable and fast.

Key words: Laparoscopic total hysterectomy, Ligasure, Vessel sealing system, Energy instrument
表1 腹腔镜全子宫切除术患者的两组一般资料比较
组别 例数 年龄 (岁， ±s) 体质量指数 (kg/m2， ±s) 腹部手术史[例(%)] 疾病构成[例(%)]
子宫肌瘤 子宫腺肌症 宫颈上皮内瘤变 子宫内膜病变 月经过多/不规则出血
观察组 56 49.3 ± 6.9 24.5 ± 2.9 8(14.3) 17(30.4) 6(10.7) 16(28.6) 8(14.3) 9(16.1)
对照组 64 48.7 ± 6.5 25.1 ± 3.2 11(17.2) 25(39.1) 5(7.8) 17(26.6) 6(9.4) 11(17.2)
t值或χ2值 ? 0.490 1.070 0.189 1.605
P值 ? 0.625 0.287 0.664 0.808
表2 腹腔镜全子宫切除术患者的两组手术相关指标比较
组别 例数 手术时间(min， ±s) 术中出血量(ml， ±s) 输血[例(%)] 住院时间(d， ±s) 中转开腹[例(%)] 并发症发生[例(%)]
观察组 56 46.6 ± 19.1 51.0 ± 21.9 2(3.6) 6.3 ± 2.2 0(0.0) 4(7.1)
对照组 64 65.8 ± 29.2 118.4 ± 50.7 6(9.4) 6.7 ± 2.8 2(3.1) 7(10.9)
t值或χ2值 ? 4.196 9.220 1.617 0.861 1.780 0.517
P值 ? <0.001 <0.001 0.204 0.391 0.182 0.472
1
朱兰，郎景和，刘珠凤，等．三种途径子宫切除术的临床评估 [J]. 中国实用妇科与产科杂志，2003, 19 (10): 623-625.
2
贺红英，李力，陈江鸿，等. 腹腔镜子宫切除术治疗妇科良性疾病疗效的系统评价 [J]. 中国循证医学杂志，2013, 13(1): 62-69.
3
Rothmund R, Kraemer B, Brucker S, et al. Laparoscopic supracervical hysterectomy using enseal vs standard bipolar coagulation technique: randomized controlled trial [J]. J Minim Invasive Gynecol, 2013, 20 (5): 661-666.
4
常蕊，刘阳，冯彩霞，等．改良腹腔镜辅助阴式切除巨大子宫临床疗效探究[J/CD]. 中华腔镜外科杂志：电子版，2016, 9 (3): 168-171.
5
Law KS, Lyons SD. Comparative studies of energy sources in gynecologic laparoscopy [J]. J Minim Invasive Gynecol, 2013, 20 (3): 308-318.
6
苏园园，韩燕华，张樱樱，等．LigaSure与超声刀在全腹腔镜子宫切除术中的应用 [J]. 中国微创外科杂志，2009, 15 (7): 613-614.
7
Tan EK, Cornish J, Darzi AW, et al. Meta－analysis of short－term outcomes of randomized controlled trials of LigaSure vs conventional hemorrhoidectomy [J]. Arch Surg, 2007, 142 (12): 1209-1218.
8
Fagotti A, Vizzielli G, Fanfani F, et al. Randomized study comparing use of THUNDERBEAT technology vs standard electrosurgery during laparoscopic radical hysterectomy and pelvic lymphadenectomy for gynecologic cancer [J]. J Minim Invasive Gynecol, 2014, 21 (3): 447-453.
9
Elhao M, Abdallah K, Serag I, et al. Efficacy of using electrosurgical bipolar vessel sealing during vaginal hysterectomy in patients with different degrees of operative difficulty: a randomised controlled trial [J]. Eur J Obstet Gynecol Reprod Biol, 2009, 147 (1): 86-90.
10
Pergialiotis V, Vlachos D, Rodolakis A, et al. Electrosurgical bipolar vessel sealing for vaginal hysterectomies [J]. Arch Gynecol Obstet, 2014, 290 (2): 215-222.
11
Aytan H, Nazik H, Narin R, et al. Comparison of the use of ligasure, halo pks cutting forceps and enseal tissue sealer in total laparoscopic hysterectomy: a randomized trial [J]. Journal of Minimally Invasive Gynecology, 2014, 21 (4): 650-655.
12
Kim TH, Kim TJ, Yoo HN, et al. Is laparoendoscopic single－site surgery (LESS) retroperitoneal hysterectomy feasible: surgical outcomes of the initial 27 cases [J]. Taiwan J Obstet Gynecol, 2015, 54 (2): 150-154.
13
郭丙静，蔡仙丽，程爱花．Ligasure在腹腔镜辅助阴式子宫切除术中的应用 [J]. 肿瘤学杂志，2011, 17 (5): 393-394.
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