改良腹腔镜辅助阴式切除巨大子宫临床疗效探究

Clinical effect of improved laparoscopic assisted vaginal hysterectomy for the removal of large uterus

目的评估改良腹腔镜辅助阴式子宫切除术(LAVH)切除巨大子宫的临床疗效,探讨其价值和意义。方法回顾性分析180例接受LAVH患者的临床资料,平均年龄(49.4±8.5)岁,分为观察组(子宫体积≥12孕周)和对照组(子宫体积<12孕周),比较两组的一般资料、手术时间、术中出血量、输血率、平均住院时间、并发症发生率、中转开腹率等指标。结果两组的平均年龄、体质量指数符合正态分布且差异无统计学意义;观察组子宫体积较对照组大[(15.4±3.6)孕周vs(7.6±2.2)孕周],两组疾病构成亦有区异(P<0.001);观察组的平均手术时间[(83.9±32.9)min vs(50.6±20.8)min(P<0.001)]、术中出血量[(259.4±122.6)ml vs(150.9±95.1)ml(P<0.001)]和输血率[8例(10.3%)vs 2例(2.0%)(P=0.016)]均多于对照组,差异有统计学意义;两组手术并发症发生率、平均住院时间和中转开腹率差异无统计学意义。结论改良LAVH切除巨大子宫是安全、可靠的,尽管观察组术中出血量和手术时间高于对照组,但并不增加手术并发症发生率和平均住院时间,需注意适应证的选择和术者手术技巧的掌握。

Objective To evaluate the clinical effect of the improved laparoscopic assisted vaginal hysterectomy for the removal of huge uterine and to explore its value and significance. Methods The clinical data of 180 patients undergoing laparoscopic assisted vaginal hysterectomy were analyzed retrospectively. Average age（49.4 ±8.5） years old. All patients were divided into observation group （uterine , 12 weeks） and control group （uterus 〈 12 weeks） . Indicators were compared with the two groups of cases of general informa-tion, operation time, blood loss, blood transfusion rate, average hospitalization days, incidence of complications, and conversion rate. Results There were no statistically significant differences between the two groups in terms of age and BMI. The uterine size of the observation group was larger than that of the control group [（15.4 ± 3. 6） weeks （7. 6 ± 2.2 ） we e k s ] ,and there were also differences in disease constitute between two groups （P 〈 0. 001 ）. In the observation group,the average operation time [（ 83. 9 ± 32. 9 ） min vs （5 0. 6 ± 20. 8）min（P 〈0.001） ] , intraoperative blood loss[ （259.4 ± 122. 6） ml （ 150. 9 ± 95. 1 ） ml （P〈0.001）] and blood transfusion rate[8（10. 3% ）vs （ 2 . 0% ） （P = 0.016 ） ] were more than those in the control group, the difference was statistically significant. There was no significant difference between the two groups in the in-cidence of surgical complications, the average hospitalization days and the rate of conversion to laparotomy. Conclusions The improved laparoscopic assisted vaginal hysterectomy for the removal of the uterus is safe and reliable. Although the amount of intraoperative bleeding and operation time in the observation group was higher than the control group, but the incidence of surgical complications and the average hospitalization days did not increase. Following strict operation indications and operation technique are the keys to get the best result.