腹腔镜保留子宫血管全子宫切除术30例临床分析

Clinical Analysis of 30 Cases Undergone Laparoscopic Total Hysterectomy of Reserving the Uterine Vascular

目的探讨腹腔镜保留子宫血管全子宫切除术的可行性和安全性及其临床应用价值。方法将子宫良性病变无生育要求的60例患者随机分为腹腔镜保留子宫血管的全子宫切除术组(研究组,n=30)和传统常规腹腔镜全子宫切除术组(对照组,n=30),详细记录两组手术有关指标:手术时间、术中出血、术前术后血红蛋白变化、术后排气时间,术前及术后1年血FSH,E2变化,血脂变化及绝经相关症状评分Kupperman指数进行分析比较。结果两组在手术时间、术中出血、术前术后血红蛋白变化、术后排气时间等方面差异无统计学意义(P>0.05),研究组手术前后FSH、LH、E2、TC、TG、HDL和LDL间差异无统计学意义(P>0.05),围绝经期症状轻;对照组术后1年血FSH明显增高,E2降低(P<0.05),血脂发生了明显变化,表现为TC、LDL浓度升高(P<0.05-P<0.01),HDL明显降低(P<0.01),而甘油三酯无明显变化,围绝经期症状重。结论腹腔镜保留子宫血管全子宫切除术是一种临床上安全、有效的治疗子宫良性病变的方法,保留了卵巢的血液供应,对卵巢的内分泌功能无明显影响,对血脂影响小,而且其疗效确切,创伤小,该方法有可能成为未来无生育要求子宫良性病变手术的首选治疗方法。

Objective To investigate the feasibility and safety and clinical application value of laparoscopic total hysterectomy of reserving the uterine vascular. Methods 60 patients with the benign uterine diseases without fertility requirements were randomly divided into laparoscopic total hysterectomy group of uterine blood vessels （study group, n = 30） and conventional laparoscopic hysterectomy group（control group, n = 30）, A detailed record of two groups of operation related index： operation time, intraoperative hemorrhage, the change of hemoglobin before and after operation, the time of postoperative exhaust, changes of serum FSH, E2 preoperative and postoperative 1 years , Changes of blood lipid and menopausal symptoms score, Kupperman index between groups were analyzed and compared. Results：There were no significant differences in the operation time, intraoperative bleeding, postoperative hemoglobin changes, postoperative exhaust time between two groups （P 〉0.05）, the serum FSH, E2, TC, TG, HDL and LDL differences were no statistical significance before and after operation in research group（P 〉 0.05）, and perimenopausal symptom is light;While serum FSH increased signif- icantly, and serum E2 decreased in the control group after 1 years（P 〈 0.05）, and blood liquid produced apparent change, serum TC, LDL levels were elevated（ P 〈 0.05 - P 〈 0.01 ）, serum HDL decreased significantly（P 〈 0.01）, but serum TG was no obvious change, perimenopausal symptoms was serious. ConcLusions： Laparoscopic total hysterectomy of reserving the uterine vascular is an effective and safe method for the treatment of uterine benign lesions, retains ovarian blood supply, and has no significant effect on the endocrine function of ovary, little influence on blood lipid, it is effective and safe, the method has the potential to become the preferred treatment for uterine benign lesions without fertility requirements in future.