腹腔镜下全子宫切除术后阴道残端感染的病因分析与防治

Etiology analysis and prevention of vaginal stump infection after laparoscopic hysterectomy

目的腹腔镜下全子宫切除术后,对阴道残端感染的病因进行分析,以期为全子宫切除术后阴道残端感染防治提供理论依据。方法选取2016年1月至2018年10月在本院接受腹腔镜下全子宫切除术后的患者330例,分析影响腹腔镜全子宫切除术后阴道残端感染的因素。结果本研究纳入330例患者中,有21例出现术后阴道残端感染:其中年龄≥50岁占8.4%(10/119);术前阴道感染占15.6%(15/96);合并糖尿病占15.2%(12/79);术前有宫颈及宫腔操作史占10.8%(15/139);手术时间≥2小时占7.2%(13/182);术中出血量≥100 ml占6.3%(9/143);为恶性肿瘤的占3.4%(3/88)。单因素及多因素分析结果显示,术前有宫颈及宫腔操作史、合并糖尿病和术前生殖道感染是腹腔镜全子宫切除术后阴道残端感染的危险因素(P<0.05)。结论重视术前阴道准备、改善辅助性宫腔或宫颈操作前后阴道环境、合理调控围手术期血糖水平,可减少腹腔镜全子宫切除术后阴道残端发生率。

Objective To analyze the etiology of vaginal stump infection after laparoscopic hysterectomy,in order to provide a theoretical basis for prevention and treatment of vaginal stump infection after total hysterectomy.Methods A total of 330 patients who underwent laparoscopic hysterectomy from January 2016 to October 2018 were enrolled in this study.The factors affecting vaginal stump infection after laparoscopic hysterectomy were analyzed.Results Of the 330 patients,there were 21 cases of vaginal stump infection,8.4%(10/119)of age≥50 years old,vaginal infection rate of 15.6%(15/96)before surgery,15.2%(12/79)of diabetes mellitus,10.8%(15/139)of preoperative cervix and uterine operation history,7.1%(13/182)of operation time≥2 hours,6.3%(9/143)of intraoperative blood loss≥100 ml,3.4%(3/88)of malignant tumors.Univariate and multivariate analysis results showed that preoperative cervical and intrauterine operation history,diabetes mellitus,and preoperative genital tract infection were risk factors of vaginal stump infection after laparoscopic hysterectomy(P<0.05).Conclusion Emphasis on preoperative vaginal preparation,improvement of vaginal environment before and after assisted uterine cavity or cervical operation,and reasonable regulation of perioperative blood glucose level can reduce the incidence of vaginal stump after laparoscopic hysterectomy.