筋膜外、筋膜内全子宫切除术264例并发症分析

A study on complications of 264 patients after extrafascial and intrafascial abdominal hysterectomy

目的分析我院经腹筋膜内和筋膜外全子宫切除术两种手术方式术后并发症的特点,探讨相关的防治方法。方法回顾性分析我院2006年1月～2011年1月行经腹全子宫切除术患者临床病例资料264例。统计分析筋膜外全子宫切除术(A组)和筋膜内全子宫切除术(B组)近远期术后并发症发生率的差异。结果 264例患者近期并发症发生率为33.0%,远期并发症发生率为56.8%。近期并发症主要为残端出血(15.9%)、下肢静脉血栓形成(4.2%)、尿路感染(10.6%)、切口愈合不良(1.9%)、输尿管损伤(0.4%)。其中残端出血、下肢静脉血栓形成和尿路感染的发生率两组间差异有统计学意义(P<0.05),而切口愈合不良和输尿管损伤的发生率在两组之间差异无统计学意义(P>0.05)。远期并发症主要为围绝经综合征(36.4%)、心血管系统疾患(15.9%)、残留卵巢综合征(4.5%),远期并发症两组间差异有统计学意义(P<0.05)。结论全子宫切除术应严格掌握手术指征,选择合理术式,有利于近远期并发症的防治。

Objective To complications of 264 patients after extrafaseial and intrafascial total abdominal hysterectomy （TAH） and and explore its prevention measures. Methods A total of 264 cases patients with TAH were retrospectively analyzed in our hospital. The rate pf complications in extrafascial（A） and intrafascial（B） ＇YAH group was statistically analyzed. Results In the total 264 cases, the rate of short-term complication was 33.0% ,and long-term complication rate was 56. 8%. Stump bleed- ing （ 15.9% ）, venous thrombosis （4. 2% ）, urinary tract infection （ 10. 6% ）, poor wound healing （ 1.9% ）, ureteral injury （0. 4% ） were the short-term complications. The rate of stump bleeding, venous thrombosis, and urinary tract infection were sig- nificant difference between A and B groups, respectively （P 〈 0. 05 ）. However, the rate of poor wound healing and urinary tract infection were not significant difference between A and B groups, respectively （P 〉 0. 05 ）. Perimenopausal syndrome （36. 4% ） , cardiovascular system disorders （ 15.9% ） ,residual ovary syndrome （4. 5% ） were the long-term complications. There was a signif- icant difference of long-term complications between A and group B （ P 〈 0.05 ）. Conclusion The surgical indications of TAH should be strictly controlled, and selecting a reasonable procedure is conducive to prevent and treat the short and long-term compli- cations, short-term