腹腔镜辅助阴式次全子宫切除术对中年子宫肌瘤患者术后康复及性功能的影响

Effect of laparoscopic assisted vaginal subtotal hysterectomy on the postoperative rehabilitation and sexual function in patients with middle-aged uterine fibroids

目的探讨腹腔镜辅助阴式次全子宫切除术治疗中年子宫肌瘤的临床效果。方法选择2016年11月至2018年10月重庆市开州区人民医院诊治的122例中年子宫肌瘤患者为研究对象.按照手术方式将其分为观察组与对照组,每组61例患者。观察组患者行腹腔镜辅助阴式次全子宫切除术,对照组患者行经阴道全子宫切除术。比较两组患者的手术指标、术后康复情况、术后不同时间段疼痛(VAS评分)情况、并发症发生率,随访至术后3个月,比较两组患者性功能(BISF-W评分)。结果①手术指标:两组患者肌瘤清除数目比较,其差异无统计学意义(P>0.05);观察组患者术中出血量、手术用时均优于对照组患者(均P<0.05)。②术后康复:观察组患者术后首次排气时间、下床活动时间、住院时间均短于对照组患者(均P<0.05)。③疼痛:术后两组患者VAS评分均呈下降趋势,且观察组患者下降幅度大于对照组患者,其差异均具有统计学意义(均P<0.05)。④并发症:观察组患者术后并发症总发生率(3.3%,2/61)低于对照组患者(14.8%,9/61),其差异具有统计学意义(P<0.05)。⑤性功能:手术前,两组患者BISF-W各维度评分比较,其差异均无统计学意义(均P>0.05);手术后3个月,观察组患者各维度评分均高于对照组患者,其差异均具有统计学意义(均P<0.05)。结论腹腔镜辅助阴式次全子宫切除术治疗子宫肌瘤,更具有微创优势,且术后疼痛轻、并发症少,有利于患者早期康复,对改善中年患者性功能亦有积极作用。

Objective To evaluate the clinical value of laparoscopic assisted vaginal subtotal hysterectomy for middle-aged uterine fibroids patients. Methods 122 cases of middle-aged uterine fibroids patients in our hospital from November 2016 to October 2018 were divided into observation group and control group, 61 cases in each group. The control group underwent transvaginal hysterectomy, and the observation group underwent laparoscopic assisted vaginal subtotal hysterectomy. The surgical indexes, postoperative rehabilitation, postoperative pain(VAS score), and complication rate were compared between the two groups. All the patients were followed up for 3 months after surgery and the BISF-W scores were compared between the two groups. Results ① Surgical index: there was no significant difference in the number of fibroids clearing between the two groups(all P>0.05). The amount of intraoperative blood loss and operation time in the observation group was better than that in the control group(all P<0.05). ② Postoperative rehabilitation: in observation group, the first exhaust time, the time of getting out of bed, and the hospital stay were shorter than those of the control group(all P<0.05). ③ Pain: the VAS scores of the two groups showed a downward trend, and more significant decrease was found in the observation group than that of the control group(all P<0.05);④ Complications: the total incidence of postoperative complications in the observation group(3.3%, 2/61) was lower than that in the control group(14.8%, 9/61)(P<0.05);⑤ Sexual function: there were no significant differences in the scores of BISF-W between the two groups before operation(all P>0.05) and the scores of each dimension in the observation group were higher than those in the control group at 3 months after operation(all P<0.05). Conclusions Laparoscopic assisted vaginal subtotal hysterectomy for uterine fibroids is minimally invasive, with less postoperative pain and less complications, which is beneficial to early rehabilitation of patients and has a positive effect on improving the sexual function of middle-aged patients.