腹腔镜下子宫次全切除术两种子宫动静脉处理方法的比较

Comparison of two methods for uterine artery and vein treatment in laparoscopic subtotal hysterectomy

目的对腹腔镜下子宫次全切除术两种子宫动静脉处理方法进行比较。方法选择早期开展的腹腔镜下子宫次全切除术子宫动静脉上行支予双极电凝后切断的28例[电凝组,子宫大小如孕(70.0±11.94)d]和子宫动静脉上行支予0/Ⅰ肠线路德结套扎宫颈处理组27例[套扎组,子宫大小如孕(86.3±9.26)d],比较两组患者的手术时间、术中出血量、术后最高体温、术后排气时间、术后住院时间、中转开腹率等各项指标。结果 55例患者子宫次全切除术均在腹腔镜下完成,手术经过顺利,无中转开腹者,术后病理检查均为良性病变。两组患者手术时间、术中出血量、术后最高体温、术后排气时间、术后住院时间比较差异均无统计学意义(均P>0.05)。术后3个月门诊随访,所有患者均无特殊不适主诉,B超及妇科二合诊检查也无异常发现。结论套扎宫颈阻断子宫动静脉上行支的方法手术操作比较简便,比较适用于腹腔镜下子宫次全切除术初学者及子宫较大的患者。

Objective To compare two treatment methods for uterine artery and vein in laparoscopic subtotal hysterectomy （LSH）.Methods Fifty five patients undergoing LSH in Tongxiang First People＇s Hospital were enrolled in the study.The ascending branch of uterine artery and vein was severed after electric bipolar coagulation in 28 cases （coagulation group） and the blood vessels were treated with cervical loop ligation in 27 cases （ligation group）.The operation time,intraoperative blood loss,postoperative fever,postoperative ventilation time,postoperative hospital stay,laparotomy rate were compared between two groups.Results The laparoscopic hysterectomy was completed smoothly without transferring to laparotomy in all 55 patients.There were no significant differences in operative time,intraoperative blood loss,postoperative fever,postoperative ventilation time and postoperative hospital stay between two groups （all P 〉0.05）.After 3 months of follow-up,all patients had no special complaints,and no abnormal findings in ultrasound and gynecological examinations.Conclusion Both methods are effective and safe for treatment of cervical artery and vein in laparoscopic hysterectomy,however,the ligation method is easier to handle,so it is more suitable for the beginners and the patients with lager uterus.