盆腔手术史对腹腔镜全子宫切除术短期疗效的影响

The influence of pelvic operation history on short-term therapeutic effect of total laparoscopic hysterectomy

目的:探讨有盆腔手术史的患者是否适合行腹腔镜全子宫切除术(totally laparoscopic hysterectomy,TLH)。方法:64例有盆腔手术史行TLH的患者为研究组,同期180例无盆腔手术史行TLH的患者为对照组,观察两组短期临床疗效。结果:研究组和对照组平均手术时间分别为(88.6±26.1)min和(84.3±26.6)min;术中出血量分别为(45.8±24.0)ml和(43.9±24.7)ml;术后平均住院(8.7±3.7)d和(8.5±1.6)d;手术后血红蛋白改变量分别为(-6.2±8.8)g/L和(-6.2±8.0)g/L;术后肛门排气时间分别为(1.9±0.6)d和(1.8±0.7)d;术后平均体温第1天分别为(37.0±0.3)℃、(37.0±0.4)℃,第2天分别为(36.8±0.4)℃和(36.8±0.3)℃,第3天分别为(36.7±0.2)℃和(36.7±0.2)℃,两组差异无统计学意义(P>0.05)。主要并发症:两组均有1例术中发生膀胱损伤(P>0.05);次要并发症:研究组1例不明原因发热,对照组1例切口感染,1例肠道感染,1例不明原因发热,两组差异无统计学意义(P>0.05)。结论:有盆腔手术史的患者可行TLH,为减少手术并发症和中转开腹,术前应行详细的妇科检查,选择盆腔粘连较轻的病例。

Objective：The aim of the present study was to investigate whether total laparoscopic hysterectomy（TLH） is appropriate for patients with pelvic operation history.Methods：Sixty-four patients with pelvic operation history underwent TLH were enrolled in study group.180 patients without pelvic operation experience underwent TLH were enrolled in control group.The short-term clinical therapeutic effects of the two groups were observed.Results：In study group and control group,the mean operative time was（88.6±26.1）min and（84.3±26.6）min respectively.Intraoperative blood loss was（45.8±24.0）ml and（43.9±24.7）ml respectively.Mean hospital stay was（8.7±3.7）d and（8.5±1.6）d.Change of hemoglobin concentration before and after operation was（-6.2±8.8）g/L and（-6.2±8.0）g/L.Postoperative recovery time of intestinal function was（1.9±0.6）d and（1.8±0.7）d.Average temperature on the first day after operation was（37.0±0.3）℃ and（37.0±0.4）℃.Average temperature on the second day after operation was（36.8±0.4）℃ and（36.8±0.3）℃.On the third day was（36.7±0.2）℃ and（36.7±0.2）℃.There was no significant difference between the two groups（P0.05）.The major complication included 1 case of urinary bladder injury in each group（P0.05）.The minor complications included 1 case of fever with unknown reason in study group and 1 case of incision infection,1 case of intestinal infection and 1 case of fever with unknown reason in control group.The difference was not significant（P0.05）.Conclusions：Pelvic operation history is not the contraindication of TLH.By choosing appropriate patients with minor pelvic adhesion and careful gynecological examination,operative complications and conversion to laparotomy can be reduced.