腹腔镜子宫切除术中转开腹的危险因素及结局分析

Analysis of Risk Factors and Outcome of Laparotomy in Laparoscopic Hysterectomy

目的探讨腹腔镜子宫切除术中转开腹的危险因素及结局分析。方法选取在本院2015年6月—2017年1月接受治疗的1 080例子宫切除患者作为本次研究对象,实施Logistic回归性分析,记录手术结局。结果本文研究中,中转开腹率为4.1%,其中阔韧带肌瘤11例,子宫颈肌瘤12例,子宫腺肌病16例,早期宫颈癌3例,早期子宫内膜癌2例。44例患者中,有29例有腹部手术史。中转开腹主要原因为子宫肌瘤位置特殊(17例,38.63%)及严重盆腔粘连(15例,34.09%),其次是术中出血(7例,15.91%)及副损伤(5例,11.36%),且经Logistic多元回归后,发现子宫肌瘤位置特殊,盆腔严重粘连,术中出血,副损伤为腹腔镜子宫切除术中转开腹的危险因素。结论患者子宫肌瘤位置特殊,盆腔严重粘连,术中出血,副损伤均为导致腹腔镜子宫切除术中转开腹的独立因素,故对于该类患者,临床中需严格掌握适应证,确定腹腔镜子宫切除术的可行性,以此保证手术效果,降低并发症发生率,促进患者机体康复,对于提高患者的生活质量具有重大的临床意义。

Objective To investigate the risk factors and outcomes of laparotomy in laparoscopic hysterectomy. Methods 1 080 cases of patients who underwent hysterectomy in our hospital from June 2015 to January 2017 were selected as the subjects of this study. Logistic regression analysis was performed to record the operative outcome. Results In this study, the transmutation rate was 4.1%, including 11 cases of broad ligament myoma, 12 cases of cervical myoma, 16 cases of adenomyosis, 3 cases of early cervical cancer and 2 cases of early endometrial carcinoma. Of the 44 patients, 29 cases had a history of abdominal surgery. Main reason for the transfer laparotomy for uterine fbroids location （17 cases, 38.63%） and severe pelvic adhesion （15 cases, 34.09%）, followed by intraoperative hemorrhage （7 cases, 15.91%） and deputy injury （5 cases, 11.36%）, and after Logistic multivariate regression, found that uterine fbroids, special and serious pelvic adhesion, intraoperative bleeding, vice injury as a risk factor for laparoscopic hysterectomy transfer laparotomy. Conclusion The patients with uterine fbroids position, pelvic adhesions, bleeding, injury were independent factors resulting in laparoscopic hysterectomy laparotomy, so for this kind of patients need to strictly grasp the indications in the clinical feasibility of laparoscopic hysterectomy, in order to ensure the operation efect, reduce the incidence of complications, promote the rehabilitation of patients. It is of great clinical signifcance to improve the quality of life of patients.