腹腔镜子宫次全切除术在基层医院的临床应用

Clinical application of laparoscopic subtotal hysterectomy in primary hospitals

目的探讨腹腔镜子宫次全切除术(LSH)在基层医院的临床应用。方法对2006年6月—2007年12月在浙江省舟山市普陀区人民医院妇科行子宫次全切除手术的97例患者的临床资料进行回顾性分析。根据手术方式将其分为两组:LSH组77例,开腹组20例。结果开腹组均顺利完成手术,手术时间为75～180min,平均手术时间为(114.0±27.0)min;术中出血量为90～400mL,平均出血量为(225.00±72.80)mL;术后体温正常者8例,吸收热12例,术后发热发生率为60%(12/20),平均最高体温为(37.8±0.5)℃,持续3～7d消退,中位持续时间为3.0d。LSH组均完成子宫次全切除术,其中1例行左侧卵巢切除的患者在腹腔镜下发现子宫左侧粘连致密,解剖结构不清,恐伤及肠曲而中转开腹,并顺利完成手术,手术成功率为98.7%(76/77);手术时间为40～155min,平均手术时间为(85.6±30.4)min;术中出血量为30～200mL,平均出血量为(77.27±34.32)mL;术后体温正常者47例,吸收热30例,术后发热发生率为39.0%(30/77),平均最高体温为(37.4±0.6)℃,中位持续时间为1.2d。LSH组手术时间、术中出血量、术后最高体温和术后发热天数均显著低于开腹阻(t=3.80、13.15、2.79、4.14,P值均<0.01),术后发热发生率则显著低于开腹组(χ2=4.279,P<0.05)。结论腹腔镜子宫次全切除术符合多数患者的意愿,更人性化,且手术操作相对简单,易于掌握,在基层医院是值得提倡和推广的微创术式。

Objective To investigate the indications,surgical techniques and perioperative management of laparoscopic subtotal hysterectomy（LSH）in primary hospitals.Methods Clinical data of 97 women undergoing subtotal hysterectomy during June 2006 to December 2007 in our hospital were retrospectively analyzed.The patients were divided into LSH group（n=77）and open surgery group（n=20）.Results All 20 patients from open surgery group were successfully operated,with an operation time of 78 to 180 min（mean [114.0±27.0] min）,and a perioperative blood loss of 90 to 400 mL（mean [225.00±72.80] mL）.Eight of them had normal temperature after operation,but the rest 12 ones had absorption fever（highest temperature [37.8±0.5] ℃）for 3 to 7 d（median 3.0 d）.All 76 patients of LSH group successfully completed the surgery by laparoscopy,except 1 case was transferred open surgery due to unclear anatomical structure for left ovary removal.The successful rate of LSH was 98.7%（76/77）.The surgery was finished in 40 to 155 min（mean [85.6±30.4] min）with a blood loss of 30 to 200 mL（mean [77.27±34.32] mL）.There were 47 patients having normal temperature after operation.The other 30（39.0%,30/77）had absorption fever at（37.4±0.6）℃ for 1.2 d.The operation time,blood loss,highest postoperative temperature and fever duration in LSH group were significantly lower than those of open surgery group（t=3.80,13.15,2.79,4.14,all P0.01）,and the incidence of postoperative fever in LSH group was obvious lower than that in open surgery group（χ2=4.279,P0.05）.Conclusion LSH meets the wishes of most patients,and is more humane,simple to operate,and easy to accomplish.This minimal invasive approach should be recommended and widely used in more primary hospitals.