腹腔镜子宫次全切除术的临床价值

Clinical Value of Laparoscopic Supracervical Hysterectomy

目的探讨腹腔镜子宫次全切除术(laparoscopic supracervical hysterectomy,LSH)的临床价值。方法回顾分析我院2006年7月～2007年9月78例LSH与59例开腹子宫次全切除术(abdominal supracervical hysterectomy,ASH)的临床资料,比较2种手术方式术中出血量、手术时间、肠功能恢复、术后下床时间及术后住院时间等情况。结果LSH组术中出血量(65.1±25.5)ml与ASH组(72.9±23.6)ml比较差异无显著性(t=-1.830,P=0.069);LSH组手术时间(80.3±29.6)min明显长于ASH组(62.4±13.1)min(t=4.332,P=0.000);LSH组术后肛门排气时间(26.5±8.5)h明显早于ASH组(30.9±6.7)h(t=-3.232,P=0.001);LSH组术后下床时间(32.8±6.7)h明显早于ASH组(40.4±9.7)h(t=-5.421,P=0.000);LSH组术后住院时间(7.1±0.6)d短于ASH组(7.9±0.5)d(t=-8.291,P=0.000)。2组无手术并发症发生。结论LSH较ASH的优势明显,如果腹腔镜下操作技巧熟练,腹腔镜子宫次全切除术是一种理想的术式。

Objective To explore the clinical value of laparoscopic supracervical hysterectomy （LSH）. Methods From July 2006 to September 2007, 78 cases of LSH and 59 cases of abdominal supracervical hysterectomy （ASH） were performed in our hospital. The clinical data of the patients, including intraoperative blood loss, operation time, recovery time of bowel movement, postoperative time of out-of-bed activity and postoperative hospital stay, were analyzed and compared between the two groups. Results No significant difference was found on the mean intraoperative blood loss between the LSH group and ASH group [ （65.1 ± 25.5 ） ml vs （72.9 ± 23.6） ml, t = - 1. 830, P = 0. 069 ]. Whereas, the LSH group had significantly longer operation time and earlier recovery of the gastrointestinal function [（80.3±29.6） min vs （62.4±13.1） min, t=4.332, P=0.000; and （26.5±8.5） h vs （30.9 ± 7.0） h, t = - 3. 232, P = 0. 001 ]. Furthermore, the LSH patients had out-of-bed activity and were discharged from hospital significantly earlier than the ASH group [ （32.8 ± 6.7 ） h vs （40.4 ± 9.7） h, t = - 5. 421, P = 0. 000 ; and （7.1 ± 0.6） d vs （7.9 ± 0.5 ） d, t = - 8. 291, P = 0. 000 ]. No major complication occurred in both the groups. Conclusions LSH shows great advantages over ASH. As long as surgeons are skilled in laparoseopic operation, LSH can be an ideal procedure for hysterectomy.