下腹部横切口宫颈癌根治术中不缝合腹膜及皮下脂肪的临床研究

A study of non-closure of peritoneum and subcutaneous tissue at radical hysterectomy in cervical cancer

目的:探讨下腹部横切口宫颈癌根治术中不缝合腹膜及皮下脂肪对术中、术后影响。方法:将2002年1月～2004年6月在我院行下腹部横切口宫颈癌根治术中不缝合腹膜及皮下脂肪的76例与缝合腹膜及皮下脂肪的82例进行比较。结果:不缝合腹膜及皮下脂肪缩短手术时间、术后发热时间及抗生素应用时间,术后引流液体量多,切口脂肪液化的发生率低(P<0.05)。两组的术中失血量、术后并发症(泌尿道感染、尿潴留、淋巴囊肿、切口感染、切口裂开、皮下血肿、盆腔脓肿、肠梗阻)、排气时间、术后住院时间无显著性差别(P>0.05)。结论:下腹部横切口宫颈癌根治术中不缝合腹膜及皮下脂肪缩短手术时间,并不增加术后早期并发症的发生率,建议在下腹部横切口宫颈癌根治术中不必缝合腹膜及皮下脂肪。

Objective： To evaluate the clinical outcome of non - closure of peritoneum and subcutaneous tissue at radical hysterectomy in cervical cancer for patients with lower abdominal cross incision. Methods： 158 patients with cervical cancer undergoing radical hysterectomy with lower abdominal cross incision in our hospital between January 2002 and June 2004 were divided randomly into two groups ： peritoneum and subcutaneous tissue not closed （n =76） or peritoneum and subeutaneous tissue closed （n =82） . Results： Non - closure of peritoneum and subcutaneous tissue reduces operation time, febrile duration and antibiotics requirement, increase the volume of drainage and decrease the incidence of liquefaction of the subcutaneous fat （ P 〈 0. 05 ） . No difference in the other outcome measures including blood loss, postoperative complications （ urinary tract infection, urinary retention, lymphadenocyst, wound infection, wound separation, subcutaneous haematoma, pelvic abscess and ileus）, bowel function restoration and post- operative stay （P 〉 0. 05 ） . Conclusion： Nonclosure of peritoneum and subcutaneous tissue can shorten operative time while not increasing early postoperative complications. We suggest that the closure of peritoneum and subcutaneous tissue at radical hysterectomy be abolished in lower abdominal cross incision.