腹腔镜辅助阴式困难子宫切除术69例临床分析

69 cases of laparoscopic assisted vaginal hysterectomy

目的评估腹腔镜辅助阴式困难子宫切除术的临床疗效，总结手术经验。方法回顾性分析2014年1月至2016年1月首都医科大学附属北京安贞医院收治并行腹腔镜辅助阴式子宫切除术170例患者的临床资料，根据手术方法不同分为观察组（腹腔镜辅助阴式困难子宫切除术，69例）和对照组（腹腔镜辅助阴式常规全子宫切除术，101例）。比较2组的一般资料、手术时间、术中出血量、术中转开腹率、平均住院时间、术后并发症发生率。结果2组患者年龄、体重指数、既往腹部手术史差异无统计学意义（P〉0．05）。观察组子宫肌瘤29例（42．0％）、子宫腺肌症／子宫内膜异位症17例（24．6％）多于对照组的17例（16．8％）和9例（8．9％），而观察组宫颈上皮内瘤变3例（4．3％）少于对照组35例（34．7％），差异有统计学意义（P〈0．01或P〈0．05）。观察组平均手术时间和术中出血量多于对照组，差异有统计学意义[（76±32）min比（40±25）min、（159±73）ml比（51±35）ml]（P〈0．01）；2组患者的术中转开腹率、平均住院时间、术后并发症发生率差异均无统计学意义（均P〉0．05）。结论腹腔镜辅助阴式困难子宫切除术是安全、可靠的，尽管术中出血量和手术时间多于腹腔镜辅助阴式常规全子宫切除术，但并不增加术后并发症发生率和平均住院时间。

Objective To evaluate the clinical efficacy of laparoscopic assisted vaginal hysterectomy （LAVH） and summarize operation experiences. Methods Totally 170 cases of LAVH from January 2014 to January 2016 were retrospectively analyzed and divided into observation group （LAVH for difficult uterus, 69 cases） and control group（routine total LAVH, 101 cases）. Glinical data, operation times, intraoperative blood losses, rates of converting to laparotomy, average hospitalization days and incidences of postoperative complications were analyzed between groups. Results The age, body mass index and the history of abdominal operations had no significant differences between groups（ P 〉 0. 05 ）. In terms of uterine diseases, case numbers of hysteromyoma and adenomyosis/endometriosis in observation group were significantly higher than those in control group; the case number of cervical intraepithelial neoplasia in observation group was significantly lower than that in control group [29 cases（42.0% ） vs 17 cases（ 16. 8% ）, 17 cases（24.6% ） vs 9 cases（$. 9% ）, 3 cases（4. 3% ） vs 35 cases （34, 7% ）] （P 〈0. 05 or P 〈 0. 05 ）. The operation time and intraoperative blood loss in observation group were significantly higher than those in control group[ （76 ±32）min vs （40 ±25） min, （ 159 ±73） ml vs （51 ±35）ml] （P 〈 0. 01 ）. The rate of converting to laparotomy, average hospitalization days and the incidence of postoperative complications had no significant differences between groups （P 〉 0. 05 ）. Conclusions LAVH treating difficult uterus is safe and effective. Although the operation time and intraoperative blood loss of difficult LAVH are higher than those of routine LAVH, average hospitalization days and the incidence of postoperative complications have no differences.