腹腔镜全子宫切除术中结扎束血管闭合系统的应用研究

Application of ligasure vessel sealing system in laparoscopic total hysterectomy

目的评估结扎束血管闭合系统(LF1537 Blunt Tip)在腹腔镜全子宫切除术中应用的临床疗效,探讨其临床价值。方法选取解放军总医院2014年1月至2016年1月期间收治并行腹腔镜全子宫切除术患者,根据术中是否使用结扎束血管闭合系统分为观察组(使用结扎束血管闭合系统)和对照组(常规手术),记录并比较两组的一般资料和手术相关指标。结果两组的年龄、体质量指数、腹部手术史符合正态分布且差异无统计学意义(P=0.625、0.287、0.664);两组的疾病构成差异无统计学意义(P=0.808)。观察组的手术时间[(46.6±19.1)min vs(65.8±29.2)min]和术中出血量[(51.0±21.9)ml vs(118.4±50.7)ml]均少于对照组,差异有统计学意义(P<0.001);两组的输血(2例vs 6例)、住院时间[(6.3±2.2)d vs(6.7±2.8)d]、中转开腹(0例vs 2例)、并发症发生(4例vs 7例)比较,差异无统计学意义(P=0.204、0.391、0.182、0.472)。结论本研究中将结扎束血管闭合系统(LF1537 Blunt Tip)应用于腹腔镜全子宫切除术,能够更加安全有效的对血管和组织进行闭合和切割,缩短了手术时间,减少了出血量,使手术更加可靠、快捷,具有重要临床应用价值。

Objective To evaluate the clinical effect of Ligasure Vessel Sealing System （ LF1537 Blunt Tip） in laparoscopic total hysterectomy and to explore its clinical value. Methods All patients selected in our hospital during the period of Jan. 2014 to Jan. 2016 undergoing laparoscopic total hysterectomy were analyzed. All cases were divided into observation group （ using ligasure group） and control group （conventional surgery group）. The general information and the operation related index were compared between the two groups. Results The mean age, BMI, history of previous abdominal surgery in the two groups were in the normal distribution and the difference was not statistically significant （P = 0. 625 , 0. 287, 0. 664）. The difference of disease constitute of the two groups was not statistically significant （P = 0.808）. In the observation group, the average operation time [（46. 6 ± 19. 1 ） min vs （65. 8 ± 29.2） min] and the blood loss [ （51.0 ±21.9） ml vs （118.4 ± 50.7）ml] during operation were lower than that in the control group. There were no significant difference in the rate of blood transfusion （2 cases vs 6 cases） , average length of stay [（6.3 ± 2. 2） d （6. 7 ± 2. 8 ） d ] ,rate of conversion to laparotomy （0 case vs 2 cases） , and the incidence of complications （4 cases vs 1 cases） between the two groups （P = 0.204, 0.391, 0.182, 0.472）. Conclusions In this study, Blunt Tip LF1537 was used in laparoscopic total hysterectomy. It can be more safe and effective for the vascular and tissue closure and cutting, shorten the operation time, reduce the amount of bleeding, so that the operation is more reliable and fast.