妇科腹腔镜手术放置腹腔引流在快速流程模式中的应用

The Effect of Abdominal Cavity Drainage in Gynecologic Laparoscopic Surgeries on Fast Track Model

目的:探讨妇科腹腔镜手术放置腹腔引流在快速流程模式中应用的临床意义。方法:观察和分析我院近半年行腹腔镜下子宫肌瘤挖除术和附件手术(包括卵巢囊肿剥除、附件切除、异位妊娠手术)的403例患者术后恢复情况,按手术种类和引流与否分为4组,即附件引流组、附件非引流组、肌瘤引流组、肌瘤非引流组,比较4组患者在术后恢复过程中的腹围变化、肩部和(或)膈肌的疼痛情况、肛门排气时间、体温变化、术后住院时间等。结果:附件引流组和肌瘤引流组术后48小时内腹围恢复情况、肩部和(或)膈肌疼痛缓解情况,均明显优于附件非引流组和肌瘤非引流组(P<0.05);附件引流组和肌瘤引流组术后肛门排气时间、术后体温恢复正常的时间、术后住院时间均低于附件非引流组和肌瘤非引流组(P<0.05)。结论:腹腔镜子宫肌瘤挖除术和附件手术中放宽放置腹腔引流的指征符合快速流程模式的理念,对患者术后的恢复是有利的。

Objective：To explore the clinical value of abdominal cavity drainage in gynecological laparoscopic surgery in the fast track.Model.Methods： 403 patients who had laparoscopic myomectomy or the surgery of adnexa（including oophorocystectomy,adnexectomy and ectopic pregnancy surgery） were recuited and their postoperative recovery was observed.These patients were divided into four groups according to the surgical type and with or without drainaget,namely AUD（surgery of adnexa uteri with drainage） group and AUND（surgery of adnexa uteri with no drainage） group and MD（myomectomy with drainage） group and MND（myomectomy with no drainage） group.The parameters of postoperative recovery including the change of abdominal girth body temperature,the pain of shoulder and diaphragm,the mean time of passing gas and hospital stay were compared among the four groups.Results： The recovery of abdominal girth,the disappear of pain on shoulder and diaphragm 48 hours after operation in AUD and MD group were faster than those in AUND and MND group（P0.05）.The mean time of passing gas,the recovery time of body temperature and hospital stay in AUD and MD group were shorter than those in AUND and MND group（P0.05）.Conclusions：The proper expansion of the indication of putting abdominal cavity drainage during laparoscopic myomectomy or surgery of adnexa uteri is coinsistant with the fast track model,and is good for the postoperative recovery.