两种腹腔镜下子宫切除术近远期并发症比较

Comparative analysis of clinical long and short term complications of two kinds of laparoscopic hysterectomy

目的:探讨腹腔镜下全子宫切除术和筋膜内子宫切除术后的近远期并发症及防治方法。方法:对1999年1月～2004年3月行216例腹腔镜下全子宫切除术和108例腹腔镜下筋膜内子宫切除术的患者进行回顾性分析。比较两组患者近期并发症和远期并发症的发生情况。结果:腹腔镜下全子宫切除术近期并发症以损伤性并发症、阴道残端出血为主,远期并发症以围绝经期症状及心血管疾病为主。腹腔镜下筋膜内子宫切除术近期并发症以阴道出血、宫颈残鞘积血为主,远期并发症以宫颈残鞘积液为主。腹腔镜下全子宫切除术组并发症总发生率、阴道出血和宫颈残鞘积血、积液的发生率及性生活满意率明显低于筋膜内子宫切除术组(P<0.05);围绝经期症状和心血管疾病的发生率明显高于筋膜内子宫切除术组(P<0.05)。结论:两种腹腔镜下子宫切除术都是安全、可靠的术式,但腹腔镜下全子宫切除术应注意术中损伤性并发症的发生,腹腔镜下筋膜内子宫切除术应注意宫颈残鞘出血的发生,应根据不同的病例特点选择不同的术式,并加强术后随访工作。

Objective： To investigate clinical long and short term complications of two kinds of laparoscopic hysterectomy （LH） . Methods： 108 women undergoing classic intrafascial supracervical hysterectomy （CISH） and 216 women undergoing total laparoscopic hysterectomy （TLH） from January 1999 to March 2004 were studied retrospectively. The long and short term complications of two groups were compared. Results： 216 patients undergone TLH, the short term complications were mainly injury complication, and vaginal hematocele; and the long term complications were mainly perimenopausal syndrome and cardiovascular disease. 108 patients undergone CISH, the short term complications were mainly trauma complications and colporrhagia of vagina stump; and the long term complications were mainly perimenopausal symptoms and angioeardiopathy. The incidences of all complications, vaginal hematocele, hematoeele and hydrops of vagina stump and satisfaction of sexual activity in TLH group were less than those in CISH group obviously （P 〈 0. 05 ） . The incidence of perimenopausal syndrome and cardiovascular disease in TLH group were more than those in CISH group obviously （P 〈 0. 05 ） . Conclusion： TLH and CISH both are safe, effective and reproducible procedure after proper training. But injury complication in TLH and hematoeele of vagina stump in CISH should be mandatory. It is an important way for all women to insist on postoperative follow - up by rules, but different operation should be selected by different cases.