腹腔镜全子宫切除术后阴道残端大出血相关因素分析

Analysis on the Related Factors of Massive Vaginal Bleeding after Laparoscopic Total Hysterectomy

目的研究腹腔镜全子宫切除术后阴道残端大出血相关因素。方法回顾性分析某院2010年1月1日-2020年1月1日21例腹腔镜全子宫切除术术后阴道残端大出血患者的临床资料数据作为出血组。另取同期于某院接受腹腔镜全子宫切除术治疗,但术后阴道残端无出血的20例患者为无出血组。对比2组的各项基础资料,主要包括年龄、受教育程度、阴道炎症、贫血、高血压、术前妇科手术操作情况,以及各项手术指标涵盖术前阴道准备时间、术中出血量、残端血管结扎是否不牢,进行多因素Logistic回归分析。结果出血组与无出血组在年龄、受教育程度、术前贫血、贫血程度及高血压控制效果等方面对比均无明显差异;出血组阴道炎症、高血压人数占比高于无出血组。出血组术中出血量>100ml以及术前阴道准备时间<2天均高于无出血组;而2组残端血管结扎不牢人数占比对比无明显差异。经多因素Logistic回归分析发现阴道炎症、高血压、术中高出血量>100ml以及术前阴道准备时间<2天均是腹腔镜全子宫切除术后阴道残端大出血的独立危险因素。结论腹腔镜全子宫切除术后阴道残端大出血的相关因素包括阴道炎症、术中出血量、手术方式、术前阴道准备时间。临床工作中应针对这些因素制定相应干预措施,从而达到降低术后阴道残端大出血发生风险的目的。

Objectives To study the related factors of massive vaginal stump hemorrhage after laparoscopic total hysterectomy.Methods The clinical data of 21 patients with vaginal stump bleeding after laparoscopic hysterectomy in hospital from January 1st,2010 to January 1st,2020 were analyzed retrospectively.Another 20 patients who received laparoscopic total hysterectomy in hospital at the same time,but no bleeding at the vaginal stump after operation were taken as the non bleeding group.The baseline data(mainly including age,education level,vaginitis,anemia,hypertension,preoperative gynecological operation)and operation indexes(mainly including preoperative vagina preparation time,intraoperative bleeding volume,incomplete ligation of blood vessels)were compared between the two groups,and multivariate logistic regression analysis was performed.Results There was no significant difference in age,education level and preoperative anemia,degree of anemia and the effect of hypertension control between the bleeding group and the non-bleeding group.The proportion of vaginal inflammation and hypertension in the bleeding group was higher than that in the non-bleeding group.The intraoperative blood loss of >100 ml and preoperative vaginal preparation time <2 days in the bleeding group were higher than those in the non-bleeding group.However,there was no significant difference in the proportion of patients with poor ligation of residual vessels between the two groups.Multivariate Logistic regression analysis showed that:vaginal inflammation,hypertension,intraoperative high blood loss of>100 ml and preoperative vaginal preparation time <2 days were all independent risk factors for vaginal stump hemorrhage after laparoscopic total hysterectomy.Conclusions The factors associated with massive vaginal stump hemorrhage after laparoscopic total hysterectomy included vaginal inflammation,intraoperative blood loss,surgical approach,and preoperative vaginal preparation time.In clinical work,the corresponding measures and interventions should be formulated according to the above factors,so as to reduce the risk of postoperative vaginal stump bleeding.