基层医院使用双极电凝进行完全性腹腔镜下全子宫切除术148例临床分析

Clinical analysis on 148 cases of total laparoscopic hysterectomy by bipolar coagulation in primary hospital

目的探讨基层医院应用双极电凝完成完全性腹腔镜下全子宫切除术的可行性和安全性。方法 2009年1月～2011年1月在该院就诊有全子宫切除手术指征的患者,分为腔镜组和开腹组。其中腔镜组148例采用双极电凝进行完全性腹腔镜下全子宫切除术,开腹组145例采用腹式全子宫切除术。观察两组手术成功率、手术时间、术中出血量、术中及术后并发症、术后恢复情况及住院时间等指标。结果患者均顺利完成全子宫切除术。其中腔镜组切除子宫重量平均(289±20)g;手术时间平均(85.2±10.3)min;术中出血量平均(65.±720.1)mL;肛门排气时间平均(26.5±4.6)h;出院时间平均(5.±31.2)d;术后阴道排液时间平均(13.±51.4)d;均无严重并发症发生。开腹组切除子宫重量平均(80±20)g;手术时间平均(83.3±9.1)min;术中出血量平均(93.6±22.4)mL;肛门排气时间平均(36.5±4.7)h;出院时间平均(8.3±1.3)d;术后阴道排液时间平均(15.±51.5)d;术后并发症率1.4%,为2例切口感染。两组相比手术时间和术后并发症相当,差异无显著性(P>0.05);而腔镜手术能有效减少术中出血量,并能促进术后恢复(P<0.05)。结论基层医院应用双极电凝进行完全性腹腔镜下全子宫切除术是安全可行的,与传统的开腹手术相比,腹腔镜手术创伤小,术后恢复快。

[ Objective ] To investigate the feasibility and safety of total laparoscopic hysterectomy using bipolar coagulation in primary hospitals. [Methods] From 2009~2011, in the People＇s Hospital of Louxing District, patients with surgical indication were divided into laparoscopy group and abdomen group. For laparoscopy group, 148 pa- tients underwent total laparoscopic hysterectomy using bipolar coagulation in our primary hospital. For abdomen group, 145 patients underwent abdominal hysterectomy. Such indicators were observed as success rate, operating time, intraoperative blood loss, intraoperative and postoperative complications, postoperative recovery and hospital stay. [ Results] All the patients accepted total hysterectomy operations successfully. When compared to abdomen group, for laparoscopy group the mean uterus weight was lower （289±20） g vs. （380±20） g （P 〈0.05）, the mean opera- tion time （85.2±10.3） min vs. （83.3±9.1） rain and complication rate （0.0% vs. 1.4%） were similar （P 〉0.05）, but the mean intraoperative blood loss（65.7±20.1） mL vs （93.6±22.4） mL, the mean postoperative anal exhaust time （26.5± 4.6） h vs （36.5±4.7） h, the mean postoperative discharged time （5.3±1.2） d vs （8.3±1.3） d, and the mean postopera- tive vaginal discharge time （13.5±1.4） d vs. （15.5±1.5） d were shorter （P 〈0.05）. [Conclusions] The total laparo- scopic hysterectomy using bipolar coagulation is safe and reliable in primary hospitals, which can reduce the surgery related trauma and promote an early recovery.