腹膜不关闭技术在宫颈癌根治术中的应用

Application of peritoneal non-closure technique in radical surgery of cervical carcinoma

目的 :观察腹膜关闭与否对宫颈癌根治术患者术后恢复及切口愈合的影响 ,探讨腹膜不关闭技术在妇科肿瘤手术中应用的可行性。方法 :对 1 998年 8月～ 2 0 0 1年 8月在我院因宫颈癌接受宫颈癌根治术的 852例患者随机分组 ,其中术中关闭侧腹膜和前腹膜者 40 7例 ,未关闭侧腹膜和前腹膜者共 445例 ,应用u检验和 χ2 检验比较两组的手术时间、术后肛门排气时间、抗生素应用天数、发热天数、淋巴囊肿形成、盆腔感染发生率、肠粘连肠梗阻、切口愈合情况等。结果 :与腹膜关闭组比较 ,腹膜未关闭组的手术时间、术后肛门排气时间明显缩短 ;术后发热天数减少 ;术后盆腔淋巴囊肿发生率和盆腔感染发生率降低 ;术后抗生素应用天数减少 ;术后肠粘连、肠梗阻发生率降低 ;发生切口脂肪液化或感染者明显减少 ;两组各项指标差异均有显著性 (P <0 .0 1或P <0 .0 0 1 )。结论 :虽然宫颈癌根治术手术范围广、创面大 ,不关闭前腹膜和侧腹膜却并不增加腹腔粘连的机会和影响切口的愈合 ,手术时间明显缩短 ,显示了极小的危险性。

Purpose:To assess the postoperative effects that maybe associated with the closure or non closure of peritoneum at transabdominal radical surgery of cervical carcinoma, and observe the feasibility of applying peritoneal non closure technique in gynaecological tumor operations.Methods:852 patients undergoing radical surgery in our hospital between August 1998 to August 2001 were divided randomly into two groups: peritoneum closed ( n = 407) or peritoneum open ( n = 445). Student u test and Chi square test were used for statistical analysis of the results: operative duration, bowel function restoration, febrile duration, antibiotics requirement, lymphadenocyst formation, pelvic infection and ileus and incision healing of the two groups.Results:As compared to the closure of peritoneum, the length of operation time and bowel function restoration were shorter, febrile duration was shorter, the morbidity of pelvic infection and lymphadenocyst formation were lower, antibiotics requirement was fewer, the incidence of ileus and wound infection was significantly less frequently seen in the non closure group( P <0.01 or P <0.001). Conclusions:Peritoneal non closure technique in transabdominal radical surgery of cervical carcinoma can shorten operative time significantly while not increasing postoperative complications, appears to have few risks and may be recommended in many gynaecological tumor operations. [