腹腔镜辅助下阴式全子宫切除术与腹式全子宫切除治疗子宫良性病变的效果及对盆底功能的影响比较

Comparative study on the clinical efficacy of laparoscopic assisted vaginal hysterectomy and abdominal hysterectomy in the treatment of benign uterine lesions and its influence on the pelvic floor function

目的比较腹腔镜辅助下阴式全子宫切除术与腹式全子宫切除治疗子宫良性病变的效果及对盆底功能的影响。方法选择2016年3月~2017年3月南京市妇幼保健院妇科收治的130例子宫良性病变患者,依据随机数字表法将其随机分为两组,每组65例。对照组患者采取腹式全子宫切除术,观察组患者采取腹腔镜辅助下阴式全子宫切除术进行治疗。对两组患者手术情况、性生活质量、应激指标及盆底功能障碍发生率进行比较分析。结果观察组术中出血量较对照组明显减少(P<0.05);手术时间、排气时间及下床活动时间均较对照组明显缩短(P<0.05)。治疗后观察组女性性功能指数量表总分较对照组明显提高(P<0.05),焦虑自评量表评分较治疗前和对照组明显降低(P<0.05)。治疗后观察组白细胞计数和血清皮质醇、白介素-6、C反应蛋白水平均较对照组明显降低(P<0.05)。两组盆底功能障碍发生率比较,差异无统计学意义(P>0.05)。结论腹腔镜辅助下阴式全子宫切除术可明显减少子宫良性病变患者的术中出血量,缩短手术时间及下床活动时间,缓解焦虑情绪、应激反应。

Objective To compare the clinical efficacy of laparoscopic assisted vaginal hysterectomy and abdominal hysterectomy in the treatment of benign uterine lesions and its influence on the pelvic floor function. Methods One hundred and thirty cases of patients with benign uterine lesions admitted to Department of Gynecology, Nanjing Maternity and Child Health Hospital from March 2016 to March 2017 were selected and divided into two groups by random number table, with 65 cases in each group. The control group was given abdominal hysterectomy, while the observation group was given laparoscopic assisted vaginal hysterectomy. The operative conditions, sexual quality of life, stress indexes and incidence of pelvic floor dysfunction of patients in the two groups were compared and analyzed. Results After treatment, intraoperative blood loss of observation group were less than the control group, the operative time, postoperative exhaust time and postoperative activity time in observation group were shorter than the control group, the differences were statistically significant（P〈0.05）. The total score of female sexual function index in observation group was higher than the control group, the difference was statistically significant（P〈0.05）, the scores of self-rating anxiety scale in observation group were lower than those before treatment and the control group, the differences were statistically significant（P〈0.05）. After treatment, the white blood cell count and the levels of serum cortisol, interleukin-6 and C-reactive protein in observation group were lower than the control group, the differences were statistically significant（P〈0.05）. There were no statistically significant differences on the incidence of pelvic floor dysfunction between the two groups（P〈0.05）. Conclusion Laparoscopic assisted vaginal hysterectomy can effectively reduce intraoperative blood loss, shorten the operative time and postoperative activity time, relieve anxiety and stress response.