腹腔镜与开腹手术治疗卵巢良性肿瘤2141例临床分析

Laparoscopy vs.Laparotomy for Benign Ovarian Tumor: Analysis of 2141 Cases

目的探讨腹腔镜手术治疗卵巢良性肿瘤的临床价值。方法回顾分析2010年1月～2011年9月2141例行腹腔镜(770例)或开腹(1371例)手术治疗的卵巢良性肿瘤患者的临床资料,其中384例行患侧附件切除,1757例行肿瘤剔除。比较两组围手术期情况及住院费用。结果术后病理诊断为卵巢良性畸胎瘤899例,卵巢单纯性囊肿124例,卵巢囊腺瘤1070例,卵巢纤维瘤48例。与开腹组相比,腹腔镜组患者年轻[(32.7±9.4)岁vs.(39.7±13.8)岁,t=-12.499,P=0.000],肿瘤小[(6.03±1.85)cm vs.(6.83±2.37)cm,t=-8.085,P=0.000]。腹腔镜组手术时间早[(61.5±8.5)min vs.(72.5±7.1)min,t=-32.084,P=0.000],术中出血少[(75.0±10.5)ml vs.(105.5±9.0)ml,t=-70.796,P=0.000],术后排气早[(10.5±4.1)h vs.(33.0±9.6)h,t=-62.046,P=0.000],下床活动早[(12.5±1.8)h vs.(36.7±10.9)h,t=-61.010,P=0.000],术后住院时间短[(4.7±1.2)d vs.(8.9±2.3)d,t=-46.904,P=0.000];但住院费用高[(15 172±2876)元vs.(11 576±2851)元,t=27.919,P=0.000]。结论对卵巢良性肿瘤实施腹腔镜手术较之开腹手术治疗,手术出血少,术后恢复快,有较大的应用价值,值得推广。

Objective To explore the value of laparoscopy for benign ovarian tumor. Methods We retrospectively analyzed the data of 2141 patients with benign ovarian tumor, who received laparoscopy （770 eases） or laparotomy （1371 cases） from January 2010 to September 2011. Among the cases, 384 patients received unilateral oophorectomy, and the other 1757 patients underwent ovarian cystectomy. The perioperative conditions and hospitalization cost were compared between the laparoseopy and laparotomy groups. Results Postoperative pathological examination showed benign teratoma in 899 of the patients, simple ovarian cyst in 124, ovarian cystadenoma in 1070, and ovarian fibroma in 48 cases. Compared to laparotomy group, patients in laparoseopy group were significantly younger [ （32.7 ± 9.4） years vs. （39.7 ± 13.8） years, t = - 12. 499, P = 0. 000 ] , and had smaller tumor [ （6.03 ± 1.85 ） cm vs. （6.83 ± 2.37 ） cm in diameter, t = - 8. 085, P = 0. 000 ]. Furthermore, laparoseopy group had significantly shorter operation time, less intraoperative blood loss, quicker recovery of gastrointestinal function, earlier ambulation after the surgery, shorter hospital stay, but higher hospitalization cost [ （61.5 ± 8.5 ） min vs. （72.5 ± 7.1 ） min, t = - 32. 084, P = 0. 000 ; （75.0 ± 10.5） mlvs. （105.5 ＋9.0） ml, t= -70.796, P=O. 000; （10.5 ±4.1） h vs. （33.0 ±9.6） h, t= -62.046, P=0.000; （12.5 ±1.8） hvs. （36.7 ±10.9） h, t= -61.010, P=0.000; （4.7±1.2） d vs. （8.9 ±2.3） d, t= -46.904, P=0. 000; （15 172 ±2876） RMB vs. （11 576 ±2851） RMB, t =27.919, P=0.000; respectively]. Conclusions Laparoscopy is less traumatic than laparotomy with quicker postoperative recovery. We recommend it as a routine surgery.