改良腹腔镜全子宫切除术的临床应用

Clinical Evaluation of Improved Total Laparoscopic Hysterectomy

目的探讨改良腹腔镜全子宫切除术的临床应用价值。方法回顾性分析2017年3月～2018年6月腹腔镜全子宫切除术101例资料,2017年9月前应用传统腹腔镜全子宫切除术(传统组,n=50),以后应用改良腹腔镜全子宫切除术(改良组,n=51),将切开阴道前穹窿的时机调整至凝断子宫动脉之前,并将切开的阴道前穹窿作为凝断子宫动脉的标志。2组均应用加速康复外科(enhanced recovery after surgery,ERAS)理念进行围手术期管理。比较2组手术时间、术中出血量、术后排气时间等指标。结果与传统组相比,改良组手术时间短[(83. 2±31. 1) min vs.(103. 2±27. 5) min,t=-3. 418,P=0. 001],术中出血少[(39. 4±33. 2) ml vs.(56. 5±31. 4) ml,t=-2. 656,P=0. 009],术后排气早[(37. 1±10. 7) h vs.(41. 3±9. 4) h,t=-2. 105,P=0. 038]。结论改良腹腔镜全子宫切除术安全、有效,兼具创伤小、手术时间短、术后恢复快等特点,值得推广。

Objective To explore the clinical value of improved total laparoscopic hysterectomy.Methods A retrospective study of 101 cases of total laparoscopic hysterectomy from March 2017 to June 2018 was conducted.The traditional total laparoscopic hysterectomy was applied before September 2017 ( traditional group, n = 50), and the improved total laparoscopic hysterectomy was applied after September 2017 ( improved group, n = 51).In the improved group, the anterior vaginal fornix was incised prior to coagulation of the uterine artery, which was as an indication for locating the position of the coagulated uterine artery.All the patients were given enhanced recovery after surgery ( ERAS) for perioperative management.The operation time, intraoperative blood loss, postoperative exhaust time, and other indicators were compared between the two groups.Results The operation time of the improved group [(83.2 ± 31.1) min] was shorter than that of the traditional group [(103.2 ± 27.5) min, t =- 3.418, P = 0.001].The intraoperative blood loss of the improved group [(39.4 ± 33.2) ml] was less than that of the traditional group [(56.5 ± 31.4) ml, t =- 2.656, P = 0.009].The postoperative exhaust time of the improved group [(37.1 ± 10.7) h] was shorter than that of the traditional group [(41.3 ± 9.4) h, t =- 2.105, P = 0.038].Conclusions The improved total laparoscopic hysterectomy is safe and effective.It has the characteristics of small trauma, short operation time and rapid postoperative recovery, which is worthy of clinical promotion.