经脐单孔腹腔镜全子宫切除术不同途径缝合阴道残端的研究

Study of different methods of suture of vaginal stump in transumbilical single-port laparoscopic total hysterectomy

目的比较经脐单孔腹腔镜全子宫切除术采用倒刺线经不同途径缝合阴道残端的效果。方法选取因子宫良性疾病接受经脐单孔腹腔镜全子宫切除术患者56例。56例均采用倒刺线缝合,经腹腔镜缝合阴道残端者被纳入A组(30例),经阴道缝合阴道残端者被纳入B组(26例)。比较2组的术中失血量、手术操作时间、术后住院日数、阴道残端总并发症(术后阴道残端出血、阴道残端感染、阴道残端裂开)、术后阴道残端息肉形成率。结果2组均能顺利完成单孔腹腔镜全子宫切除术。A组手术操作时间和缝合时间均少于B组(P均<0.05)。术后A组出现1例阴道残端裂开,B组则无(P>0.05)。A组术后阴道残端息肉形成率高于B组(P<0.05)。A组术后阴道残端总并发症发生率高于B组(P<0.05),但2组术后阴道残端出血、阴道残端感染、阴道残端裂开发生率差异则无统计学意义(P均>0.05)。结论经脐单孔腹腔镜全子宫切除术采用倒刺线经腹腔镜缝合阴道残端有利于阴道残端的愈合,可降低术后残端并发症发生率。

Objective To compare the effect of different methods of suturing vaginal stump with barbed thread in transumbilical single-port laparoscopic total hysterectomy.Methods A total of 56 patients with benign uterine diseases who underwent transumbilical single-port laparoscopic total hysterectomy were selected in this study.All 56 patients were sutured with barbed thread.Patients undergoing laparoscopic suture of vaginal stump were allocated into group A(n=30),and those receiving transvaginal suture of vaginal stump were assigned into group B(n=26).The intraoperative blood loss,operation time,length of postoperative hospital stay,total vaginal stump complications(postoperative vaginal stump bleeding,vaginal stump infection and vaginal stump dehiscence)and incidence of postoperative vaginal stump polyps were statistically compared between two groups.Results All patients in both groups successfully completed single-port laparoscopic total hysterectomy.The operation time and suture time in group A were significantly shorter than those in group B(both P<0.05).In group A,1 patient presented with vaginal dehiscence and no vaginal dehiscence in group B(P>0.05).The incidence of postoperative vaginal stump polyps in group A was considerably higher than that in group B(P<0.05).In group A,the incidence of vaginal stump complications was significantly higher than that in group B(P<0.05),whereas the incidence of vaginal stump bleeding,vaginal stump infection and vaginal dehiscence did not significantly differ between two groups(all P>0.05).Conclusion Transumbilical single-port laparoscopic total hysterectomy via laparoscopic suture of vaginal stump is beneficial to the healing of vaginal stump and reduces the incidence of postoperative vaginal stump complications.