经腹与腹腔镜全子宫切除术的临床对照研究

The comparative study of laparoscopic and abdominal hysterectomy

目的:探讨腹腔镜、子宫切除术(laparoscopic hysterectomy,LH)和经腹子宫切除术手术方式的利弊。方法:对我院2009年至2013年有全子宫切除手术指征120例患者,随机分为腹腔镜组和开腹组。进行临床对照分析,比较腹腔镜组在手术出血量、术后排气时间、手术时间、住院天数及术后镇痛药物的使用方面与开腹组的差异。结果:腹腔镜组术后的排气时间为(29.57±10.3)h,开腹组术后的排气时间为(49.7±12.3)h,差异有统计学意义(P<0.01);腹腔镜组的住院时间为(7.3±2.31)d,开腹组的住院时间为(9.1±3.33)d,差异有统计学意义(P<0.01);腔镜组术后使用镇痛药物有3例,明显少于开腹组38例(P<0.01);腹腔镜组术中出血量(100.5±15.6)m L明显少于开腹组的(156.3±37.6)m L(P<0.01),两组在手术时间无统计学差异(P>0.05)。结论:LH患者损伤小、腹部切口瘢痕不明显、肠蠕动恢复快,术中出血量少、术后下床活动早、疼痛轻,LH是我们未来继续发展的方向。

Objectives： To investigate the advantages and disadvantages of laparoscopic hysterectomy （LH） and total abdominal hysterectomy （TAH）. Methods： 120 patients with hysterectomy operation indications in our hospital from 2009 to 2013 were randomly divided into two groups ： laparoscopie group and laparotomy group. Com- parative analysis of bleeding volume, postoperative exhaust hours, operation time, hospitalization time and postoper- ative analgesic drug of the two groups was conducted. Results： The exhaust time after surgery of laparoscopic group and laparotomy group was （29.57 ± 10.3 h） and （49.7 ± 12.3 h） respectively, with statistically significant differ- ence （ P 〈 0.01 ） ; the hospitalization time of laparoscopie group and laparotomy group was （7.3 ± 2.31 d） and （9. 1 ± 3.33 d） respectively, with statistically significant difference （P 〈 0.01 ） ; the postoperative usage of analge- sic drug in laparoscopic group was 3, which was significantly less than the 38 cases in laparotomy group （P 〈 0. 01 ） ; the amount of bleeding during operation in laparoscopic group （ 100.5 ± 15.6 ml） was significantly shorter than that in laparoscopic group （156.3 ± 37.6） （P 〈 0.01 ）. The operation time of the two groups was of no signifi- cant difference （P 〈 0.05）. Conclusion： Laparoscopic hysterectomy, with little injury, not obvious abdominal in- cision, fast recover of gastrointestinal function, less bleeding during operation, earlier postoperative ambulation and light pain, is our future development direction.