腹腔镜在如孕16周及以上巨大子宫切除术中的应用分析

Application of Laparoscopy in Hysterectomy for Large Uteri as Big as More Than 16 Weeks of Gestation

目的:探讨如孕16周及以上的巨大子宫在腹腔镜下行全子宫切除术的安全性及手术技巧。方法:回顾性分析我院2018年1月—2020年6月收治的71例子宫增大如孕16~36周、术前诊断子宫肌瘤或子宫腺肌症的患者临床资料,其中43例行腹腔镜全子宫切除术(LTH,LTH组),28例行开腹全子宫切除术(TAH,TAH组)。比较2组手术时间、术中出血量、术后排气时间、住院时间、术后D-二聚体值。结果:LTH组所有病例均在镜下完成,无中转开腹病例。LIH组与TAH组手术时间无统计学差异(P=0.289),术中出血量虽无统计学差异,但LTH组术中平均出血量较少[(105.35±179.1)ml VS(213.21±338.9)ml,P=0.130];与TAH组比较,LTH组术后排气早、住院时间短、D-二聚体值低(P<0.05)。结论:腹腔镜手术较开腹手术在如孕16周以上巨大子宫切除术中,术后排气时间早、住院时间短、发生血栓风险较低,总体优势大于开腹手术,但对术者技术及器械要求较高。但对于子宫肌瘤>10cm,生长迅速,不能除外子宫恶性肿瘤的患者,行腹腔镜手术有增加腹腔、阴道残端播散种植风险,需首选开腹手术。

Objective:To explore the safety and surgical skills of laparoscopic hysterectomy for large uterus like the gestation age of 16 weeks or more.Methods:From January 2018 to June 2020,the cinical data of 71 patients with uterine enlargement,whose uterus like that with 16~36 weeks of gestation,were analyzed retrospectively,and they were diagnosed as hysteromyoma or adenomyosis before operation,including 43 cases of total laparoscopic hysterectomy(LTH group)and 28 cases of total abdominal hysterectomy(TAH group).The operation time,intraoperative blood loss,postoperative exhaust time,hospitalization time and postoperative D-dimer value were compared between patients in the two groups.Results:All cases in the LTH group were completed under the laparoscopy,and no case was converted to laparotomy.There was no significant difference in operation time between patients in LIH group and TAH group(P=0.289).Although there was no significant difference in intraoperative blood loss,the average intraoperative blood loss in patients of the LTH group was less than the LTH group[(105.35±179.1)ml VS(213.21±338.9)ml,P=0.130],the postoperative flatus was earlier in the LTH group,the hospital stay was shorter in the LTH group,and the D-dimer value was lower in the LTH group(P<0.05).Conclusion:Compared with laparotomy surgery,laparoscopic surgery has earlier postoperative exhaust time,shorter hospital stay and lower risk of thrombosis in giant hysterectomy for patients with uterus like that with over 16 weeks of pregnancy.The overall advantage of laparoscopic surgery is greater than laparotomy surgery,but it requires higher technical and equipment requirements for the operator.For patients with uterine leiomyoma>10cm,rapid growth and uterine malignant tumor cannot be excluded,laparoscopic surgery increases the risk of dissemination and implantation of abdominal and vaginal stump,and laparotomy surgery is the first choice.