对比分析腹腔镜辅助阴式全子宫切除术(LAVH)与腹腔镜下全子宫切除术(LTH)的临床效果

A Comparative Analysis of the Clinical Outcomes of Laparoscopic Assisted Negative Total Hysterectomy(LAVH)and Laparoscopic Total Hysterectomy(LTH)

目的比较腹腔镜辅助下阴式子宫切除术(laparoscopic-assisted vaginal hysterectomy,LAVH)与腹腔镜下全子宫切除术(laparoscopic total hysterectomy,LTH)的临床效果。方法回顾性分析2018年5月—2021年5月扬州洪泉医院的128例全子宫+双侧输卵管切除或全子宫+双侧附件切除术治疗患者的临床资料,其中64例LAVH治疗的患者纳入对照组,64例LTH治疗的患者纳入观察组,比较两组手术指征、治疗前后炎性因子水平与术后恢复及并发症发生情况。结果观察组手术时间短于对照组[(90.65±16.40)min vs(98.50±15.50)min],差异有统计学意义(t=2.783,P<0.05);观察组术中出血量低于对照组[(105.20±20.60)mL vs(138.50±31.20)mL],差异有统计学意义(t=7.125,P<0.05);观察组阴道切口长度短于对照组[(2.20±0.40)cm vs(6.00±1.20)cm],差异有统计学意义(t=24.033,P<0.05);观察组术后1 d的CRP水平为(28.46±7.12)mg/L、IL-8水平为(69.45±10.24)g/L,TNF-α水平为(6.11±2.17)ng/L,均低于对照组,差异有统计学意义(t=8.502、9.168、11.600,P<0.05);观察组并发症发生率低于对照组(3.12%vs 20.31%),差异有统计学意义(χ2=9.138,P<0.05)。结论采用LTH行全子宫切除的效果更确切,术后机体炎性反应更小,并发症更少,安全性更高。

Objective To compare the clinical results of laparoscopically assisted negative hysterectomy(LAVH)with laparoscopic total hysterectomy(LTH).Methods The clinical data of 128 patients treated with total hysterectomy plus bilateral salpingectomy or total hysterectomy plus bilateral adnexectomy in Yangzhou Hongquan Hospital from May 2018 to May 2021 were retrospectively analyzed.Among them,64 patients treated with LAVH were included in the control group,and 64 patients treated with LTH were included in the observation group.The surgical indications,inflammatory factors before and after treatment,postoperative recovery and complications were compared between the two groups.Results The operation time of the observation group was shorter than that of the control group[(90.65±16.40)min vs(98.50±15.50)min],and the difference was statistically significant(t=2.783,P<0.05).The intraoperative blood loss of the observation group was lower than that of the control group[(105.20±20.60)mL vs(138.50±31.20)mL],and the difference was statistically significant(t=7.125,P<0.05).The length of vaginal incision scar of the observation group was shorter than that of the control group[(2.20±0.40)cm vs(6.00±1.20)cm],and the difference was statistically significant(t=24.033,P<0.05);the levels of CRP,IL-8 and TNF-α in the observation group at 1 d after operation were(28.46±7.12)mg/L,(69.45±10.24)g/L and(6.11±2.17)ng/L,which were lower than those in the control group,and the differences were statistically significant(t=8.502,9.168,11.600,P<0.05);the complication rate of the observation group was lower than that of the control group(3.12%vs 20.31%),and the difference was statistically significant(χ^(2)=9.138,P<0.05).Conclusion Total hysterectomy using LTH has more definite results,less postoperative organism inflammatory response,less complications and higher safety.