腹腔镜辅助阴式子宫切除术31例临床分析

Clinical analysis of 31 cases laparoscopic assisted vaginal hysterectomy

目的:比较腹腔镜辅助阴式子宫切除术(laparoscopic assisted vaginal hysterectomy,LAVH)与经腹全子宫切除术(total abdominal hysterectomy,TAH)的临床效果,检测两种术式对机体应激的影响,探讨子宫切除的最佳术式。方法:以LAVH组(31例)为观察组,TAH组(33例)为对照组,比较两组患者的出血量、平均手术时间、术后住院时间、术后病率、切口疼痛情况、恢复情况等,同时检测两组术前、术后外周血中皮质醇(Cortisol,Cor)的变化,评估两种术式对机体应激的影响。结果:观察组较对照组术后切口疼痛轻,恢复肛门排气时间短,术后病率低(3.50%),住院时间短及术后恢复工作时间短,差异有统计学意义(P<0.05)。两组术后24h外周血Cor均升高,观察组术后24h外周血Cor平均(190.78±56.35)nmol/L,与术前24h[平均(121.56±15.46)nmol/L]相比升高不显著,对照组术后24h外周血Cor平均(397.23±92.39)nmol/L,较术前24h[平均(129.53±16.34)nmol/L]明显升高,两组差异有统计学意义(P<0.05)。结论:LAVH患者创伤小,康复快,是值得在基层医院推广的微创术式。

Objective：To compare the clinical effects of laparoscopic assisted vaginal hysterectomy（LAVH） with total abdominal hysterectomy（TAH）,detect their impact on physical stress,and explore the best hysterectomy.Methods：The observative group included 31 patients underwent LAVH,the control group consisted of 33 patients underwent TAH.The blood loss,mean operative time,postoperative hospital stay,postoperative morbidity,pain of incision,recovery of 2 groups were compared.The changes of preoperative and postoperative cortisol（Cor） in peripheral blood were detected in the two groups,in order to assess the impact on physical stress.Results：Compared with the control group,the postoperative incision pain of the observative group was weaker,the time of restoring anal exhaust was shorter [（23.10 ± 2.76）h],postoperative morbidity was lower（3.50%）,hospital stay was shorter [（7.5±1.78）d],the time of postoperative recovery was shorter[（20±5.67）d],and the difference was statistically significant（P0.05）.Peripheral blood Cor levels of both groups increased 24h after surgery,the average peripheral blood levels of Cor in the observation group was（190.78±56.35）nmol/L 24h after operation,compared with the average of（121.56±15.46）nmol/L 24h before operation,its increase was not significant.In the control group,the average peripheral blood level of Cor was（397.23±92.39）nmol/L,compared with the average of（129.53±16.34）nmol/L 24h before surgery,it was significantly elevated,the difference was statistically significant（P0.05） between 2 groups.Conclusions：LAVH is minimally invasive surgery deserving to be generalized in primary hospital,with less trauma and faster recovery.