子宫切除术并发症的临床分析

Complications of hysterectomy ： analysis of 162 cases

目的以患者延迟出院原因为线索，分析子宫切除术的并发症。方法选择子宫切除术后住院时间超过95％百分位（称为延迟出院）的患者资料，对并发症进行回顾分析。结果（1）在3722例接受子宫切除术的患者中，162例因手术相关原因延迟出院。114例有术后发热（占所有3722例子宫切除术的30．6‰），其中82例（71．9％）可用一种或多种并发症解释。（2）常见并发症包括：盆腔血肿／阴道残端出血（46例，12．4‰）、伤口裂开／伤口感染（24例，6．4‰）、邻近脏器损伤（20例，5．4‰）、术后尿潴留（20例，5．4‰）、术后感染（20例，5．4‰）和下肢深静脉血栓（10例，2．7‰）。（3）开腹子宫切除术的邻近脏器损伤率高于腹腔镜子宫切除和阴式子宫切除（分别为7．6‰、2．1‰和0），腹腔镜子宫切除和阴式子宫切除发生盆腔血肿／阴道残端出血的比例高于开腹子宫切除（分别为16．5‰，30．8‰和7．6‰）。（4）伤口裂开／感染仅发生于开腹子宫切除术患者，主要与某些并存疾病或状态有关。结论以延迟出院原因为线索能较准确地对子宫切除术的并发症进行分析；子宫切除术的并发症与手术途径、疾病特点和手术医师的经验有关。

Objective To evaluate the complications of different approaches of hysterectomy based on analyzing the records of patients with long post-operative hospitalization. Methods The records of 3722 patients undergoing hysterectomy due to benign gynecologic disorders were retrieved. A total of 162 patients with ultra-long post-operative hospitalization （ 〉 9 days defined as delayed discharge） were analyzed to evaluate the complications of hysterectomy. Results （ 1 ） Of 162 patients classified into delayed discharge group, 114 （30. 6‰）had post-operative fever in which 82 cases （71.9%） could be explained with complications. （2） The most common procedure-related complications included pelvic hematoma/vaginal stump bleeding （n = 46, 12.4‰） , wound dehiscence/infection （ n = 24, 6. 4‰） , organ injury （ n = 20, 5.4‰）, postoperative urinary retention（ n = 20, 5.4%0）, postoperative infection（ n = 20, 5.4‰） and lower extremity deep venous thrombosis （ n = 10,2. 7‰） . （ 3 ） Organ injury appeared to be relatively more common in abdominal hysterectomy than in laparoseopic and vaginal hysterectomy （7.6‰, 2. 1%o and 0 respectively）while pelvic hematoma /vaginal stump bleeding more common in laparoscopic and vaginal hysterectomy than in abdominal hysterectomy （ 16. 5‰, 30. 8‰ and 7. 6‰ respectively ）. （ 4 ） Wound dehiscence/infection only occurred in abdominal approach and it was closely related with some concurrent disorders. Conclusion Complications of hysterectomy are related to the approach of surgery, disease characteristics and surgeon experiences. A more accurate evaluation of compli cations might be performed on the basis of the data of patients with delayed discharge.