腹腔镜子宫切除术中经腹腔镜下缝合和经阴道缝合阴道断端的预后结局比较

Comparison of prognostic outcomes between laparoscopic suturing in laparoscopic hysterectomy and transvaginal suturing for vaginal stumps

目的比较腹腔镜子宫切除术中经腹腔镜下缝合和经阴道缝合阴道断端的预后结局。方法收集2016年1月至2019年12月在广西壮族自治区人民医院妇科行子宫切除术的341例患者的临床资料。根据患者子宫切除后关闭阴道残端的方式将其分为经阴道缝合组(阴式组,98例)和经腹腔镜下缝合组(镜下组,243例)。比较两组术后住院时间、盆腔感染、阴道断端出血、泌尿系统损伤、再次缝合、术后30 d内再入院和阴道断端愈合情况。结果两组均顺利完成手术,无中转开腹病例,无术后转重症医学科治疗病例。两组手术时间、手术出血量比较差异无统计学意义(P>0.05)。镜下组术后住院时间短于阴式组,阴式组术后30 d内再入院率高于镜下组,差异有统计学意义(P<0.05)。阴式组术后断端出血再缝合率、盆腔感染率、阴道断端裂开率以及总并发症发生率均显著高于镜下组(P<0.05)。在术后3个月和6个月,阴式组阴道残端发生息肉的人数比例均高于镜下组,差异有统计学意义(P<0.05)。进一步分析发现,术后出现盆腔感染与阴道断端发生息肉有显著关联(P<0.05)。结论腹腔镜子宫切除术经腹腔镜下缝合阴道断端有利于降低患者术后盆腔感染、阴道断端裂开、阴道断端息肉的发生率,值得临床推荐。

Objective To compare the prognostic outcomes between laparoscopic suturing in laparoscopic hysterectomy and transvaginal suturing for vaginal stumps.Methods The clinical data of 341 patients who underwent hysterectomy in the Department of Gynecology of the People′s Hospital of Guangxi Zhuang Autonomous Region from January 2016 to December 2019 were collected.The patients were divided into transvaginal suturing group(transvaginal group,98 cases)and laparoscopic suturing group(laparoscopic group,243 cases)according to different ways to close the vaginal stumps after hysterectomy.The postoperative hospitalization time,pelvic infection,bleeding from the vaginal stumps,urinary system injury,re-suturing,readmission within 30 days after surgery and healing of the vaginal stumps were compared between the two groups.Results The operations were successfully completed in both groups,and no cases were transferred to open surgery,and no cases were transferred to the Department of Critical Care Medicine for treatment after surgery.There were no significant differences in the operation time and operative blood loss between the two groups(P>0.05).The length of postoperative hospital stay in the laparoscopic group was shorter than that in the transvaginal group,and the readmission rate within 30 days after surgery in the transvaginal group was higher than that in the laparoscopic group,and the differences were statistically significant(P<0.05).The re-suturing rate of bleeding from the vaginal stumps,the pelvic infection rate,the rupture rate of vaginal stumps and the overall incidence of complications in the transvaginal group were significantly higher than those in the laparoscopic group(P<0.05).The proportions of patients with polyps on vaginal stumps in the transvaginal group were higher than those in the laparoscopic group 3 and 6 months after surgery,and the differences were statistically significant(P<0.05).Further analysis showed that postoperative pelvic infection was significantly associated with polyps on vaginal stumps(P<0.05).Conclusion Laparoscopic suturing for vaginal stumps in laparoscopic hysterectomy is beneficial to reduce the incidence rates of postoperative pelvic infection,rupture of vaginal stumps and polyps on vaginal stumps,which is worthy of clinical recommendation.