腹腔镜下子宫全切除术与经腹子宫全切术对盆底功能的影响差异

The Difference of the Effect of Laparoscopic Total Hysterectomy and Transabdominal Hysterectomy on Pelvic Floor Function

目的探讨采取腹腔镜下子宫全切除术、经腹子宫全切术的子宫良性疾病的治疗效果以及对患者术后盆底功能的影响。方法方便选取2015年1月—2017年3月该院收治的240例子宫良性疾病患者为研究对象,按手术方法不同分成观察组与对照组每组120例,对照组采取经腹子宫全切术治疗,观察组采取腹腔镜下子宫全切除术治疗,比较两组围术期指标情况,且术后随访1个月、1年及3年统计两组阴道顶端脱垂与尿失禁情况。结果观察组手术时间明显短于对照组,差异有统计学意义(t=7.458,P<0.001),观察组术中出血量明显少于对照组,差异有统计学意义(t=28.322,P<0.001),观察组术后肛门排气时间短于对照组,差异有统计学意义(t=16.117,P<0.001),观察组住院时间短于对照组,差异有统计学意义(t=15.691,P<0.001)。术后随访1个月两组阴道顶端脱垂与尿失禁发生情况上对比,差异无统计学意义(u=1.254、1.415,P>0.05);术后1年观察组阴道顶端脱垂、尿失禁发生率分别5.00%、2.30%,对照组分别为8.33%、8.33%,差异有统计学意义(u=5.241、5.023,P<0.05);术后3年观察组阴道顶端脱垂、尿失禁发生率分别3.33%、3.33%,对照组分别为11.67%、15.00%,差异具有统计学意义(u=6.541、8.441,P<0.05)。结论对子宫良性疾病,行腹腔镜下子宫全切除术具有创伤小、术后恢复快及对盆底功能影响小的优势。

Objective To investigate the therapeutic effect of laparoscopic total hysterectomy and transabdominal hysterectomy for the treatment of benign uterine diseases and the influence on the postoperative pelvic floor function of patients.Methods Conveniently Select 240 patients with uterine benign diseases admitted in the hospital from January 2015 to March 2017 as the research objects,divide into observation group and control group according to different surgical methods with 120 cases each.The control group was treated with total abdominal hysterectomy,and the observation group was treated with Laparoscopic total hysterectomy.The perioperative indicators of the two groups were compared,and the postoperative follow-up for 1 month,1 year and 3 years was followed up for statistics of vaginal top prolapse and urinary incontinence.Results The operation time of the observation group was significantly shorter than that of the control group,the difference was statistically significant(t=7.458,P<0.001),the intraoperative blood loss in the observation group was significantly less than that of the control group,the difference was statistically significant(t=28.322,P<0.001),and the postoperative anal exhaust time observation group was shorter than the control group,the difference was statistically significant(t=16.117,P<0.001),and the hospital stay in the observation group was shorter than the control group,the difference was statistically significant(t=15.691,P<0.001).There was no significant difference in the incidence of vaginal apex prolapse and urinary incontinence between the two groups after 1 month follow-up,the difference was not statistically significant(u=1.254,1.415,P>0.05);the incidence of vaginal apex prolapse and urinary incontinence in the observation group at 1 year after operation were respectively 5.00%,2.50%,the control group were 8.33%,8.33%,the difference was statistically significant(u=5.241,5.023,P<0.05);the incidence of vaginal apex prolapse and urinary incontinence in the observation group after 3 years were respectively 3.33%,3.33%,11.67% and 15.00% in the control group,respectively,the difference was statistically significant(u=6.541,8.441,P<0.05).Conclusion For benign uterine diseases,laparoscopic total hysterectomy has the advantages of less trauma,faster postoperative recovery,and less impact on pelvic floor function.