基层医院开展腹腔镜全子宫切除术术式探讨

The operating approaches of laparoscopic total hysterectomy in local hospitals

目的探讨基层医院开展腹腔镜全子宫切除术的最佳手术方式。方法对128例符合子宫切除的病例采用两种方式切除子宫,即:腹腔镜辅助经阴道子宫切除术64例占50%;腹腔镜鞘膜内全子宫切除术病例占50%。结果平均手术时间腹腔镜辅助经阴道子宫切除术组为101±23.64m in、鞘膜内全子宫切除术组为128±25.73m in,两组比较有统计学意义(t=2,P(0.05);术中平均出血量腹腔镜辅助经阴道子宫切除术组为105.37±25.53mL、鞘膜内全子宫切除术组为172.12±30.41mL,两组比较有显著的统计学意义(t=3.0,P(0.01);术后3天最高体温腹腔镜辅助经阴道子宫切除术组为38.1±0.3℃、鞘膜内全子宫切除术组为38.9±0.5℃,两组比较有显著的统计学意义(P(0.01);平均住院日腹腔镜辅助经阴道子宫切除术组为4.2±1.49d,鞘膜内全子宫切除术组为5.9±1.31d,两组比较有显著的统计学意义(P(0.01)。腹腔镜辅助经阴道子宫切除术术式在手术时间、术中出血、术后恢复方面均较鞘膜内全子宫切除术具有优势。结论腹腔镜辅助经阴道子宫切除术是基层开展腹腔镜全子宫切除术的最佳方式。

Objective To determine the best operating approach of laparoscopic total hysterectomy in local hospitals. Methods 128 patients indicated for total hysterectomy underwent laparoscopic operation in two approaches： laparoscopically assisted vaginal hystrectomy （LAVH） in 64 patients （50%） and classical intrafascial SEMM hysterectomy （CISH） in 64 patients （50%） Results The average operation time of LAVH was 101 ± 23.64 minutes; and that of CISH was 128 ± 25.73 minutes. The average operation time of LAVH groups was significantly shorter than that of CISH group（t =2.0,P 〈 0.05）. The amount of hemorrhage during operation in LAVH group 105.37 ± 25.53 mL was less than that in CISH 172.12 ± 30.41mL group significantly （ t = 3.0 ,P 〈 0.01 ）. The highest temperature at the third day after LAVH 38.1 ±0.3℃ was lower than that after the CISH 38.9 ±0.5℃ at the same time（P 〈 0.01 ）. The average hospital stay of the patients in LAVH 4.2 ± 1.49 days group was significantly shorter than that in CISH 5.9 ± 1.31days group（P 〈 0.01 ）. LAVH has many advantages in operation time, amount of hemorrhage during operation and recovery compared with CISH. Conclusion LAVH is the best approach in local hospital for laparoscopic total hysterectomy.