腹腔鏡與開腹全子宮切除術(shù)的臨床效果探討

【摘要】 目的 分析腹腔鏡與開腹全子宮切除術(shù)的臨床效果。方法 隨機(jī)選取2010年1月到2014年2月我院收治的131例因婦科疾病進(jìn)行全子宮切除患者為研究對(duì)象，將其分為治療組（腹腔鏡組）65例和對(duì)照組（開腹組）66例，后將兩組患者手術(shù)時(shí)間，術(shù)中出血量，陰道殘端出血量進(jìn)行統(tǒng)計(jì)分析。結(jié)果 腹腔鏡組患者手術(shù)時(shí)間為134±13 min明顯大于開腹組，術(shù)中出血量為110±28 ml明顯低于開腹組，陰道殘端出血量為6 ml明顯低于開腹組，P<0.05，差異顯著。結(jié)論 腹腔鏡手術(shù)治療全子宮切除對(duì)患者的創(chuàng)傷小，術(shù)后并發(fā)癥較少，但手術(shù)時(shí)間可能較傳統(tǒng)手術(shù)方式略長(zhǎng)。

doi:10.3969/j.issn.1674-9316.2015.04.217

工作單位：1 110000沈陽(yáng)和美婦產(chǎn)醫(yī)院婦科；2 028000通遼市第二人民醫(yī)院

基金項(xiàng)目：內(nèi)蒙古自治區(qū)醫(yī)療衛(wèi)生科研計(jì)劃項(xiàng)目（201303149）

To Study The Clinical Effect Of Laparoscopic Surgery And Abdominal Hysterectomy

WU Dan 1SUN Hongxia 21 Gynaecology Department，Hemei Obstetrics and Gynecology Hospital of Shenyang in Liaoning，Shenyang 110000，China; 2 The Second People's Hospital of Tongliao in Inner Mongolia，Tongliao 028000，China

【Abstract】

Objective To analyze the clinical effect of laparoscopic surgery and abdominal hysterectomy. Methods From January，2010 to February，2014，131 patients with gynecological diseases and given hysterectomy were randomly selected as the research objects. They were divided into treatment group （laparoscopic surgery group）65 cases and control group （abdominal hysterectomy group）66 cases. The surgery time，bleeding volume during surgery and the amount of vaginal stump hemorrhage were made a statistical analysis in two groups. Results In laparoscopic surgery group，the surgery time was 134±13mins，it was significantly longer than the abdominal hysterectomy group. The amount of bleeding during the surgery was 110±28ml，it was significantly lower than that of the abdominal hysterectomy group. The amount of vaginal stump hemorrhage was 6ml was significantly lower than that of the abdominal hysterectomy group，P<0.05，there was significant difference. Conclusion The laparoscopic hysterectomy for the treatment of gynecological diseases with the advantages of less trauma and less postoperative complications，but the surgery time may be slightly longer when compared with the traditional surgery.

【Key words】 Laparoscopy，Hysterectomy，Effect

在婦科疾病中子宮切除術(shù)是比較常見(jiàn)的術(shù)式，手術(shù)量?jī)H次于剖宮產(chǎn)，子宮切除術(shù)可以治療子宮良性疾病如子宮肌瘤、子宮腺肌癥、功能失調(diào)性子宮出血等又可以治療子宮一些癌癥。隨著腹腔鏡技術(shù)迅猛發(fā)展，腹腔鏡子宮切除術(shù)在婦科手術(shù)中得到了廣泛應(yīng)用 ［1］。本文中我們就腹腔鏡與開腹全子宮切除術(shù)的臨床效果進(jìn)行分析，報(bào)道如下：

1 資料與方法

1.1 臨床資料

隨機(jī)選取2010年1月到2014年2月我院收治的131例因婦科疾病進(jìn)行全子宮切除患者為研究對(duì)象，將其分為治療組（腹腔鏡組）65例和對(duì)照組（開腹組）66例。其中腹腔鏡組的65例患者中，年齡45～63歲，平均年齡（47.3±2.7）歲，其中子宮肌瘤48例，子宮腺瘤9例，功能性子宮出血8例；開腹組的66例患者中，平均年齡（48.3±3.2）歲，其中子宮肌瘤45例，子宮腺瘤11例，功能性子宮出血10例；，在年齡、疾病種類等基本資料方面，兩組具有可比性，P均＞0.05，均無(wú)顯著性差異。

1.2 方法

腔鏡組舉宮器安置好后，構(gòu)建人工CO 2氣腹，將卵巢固有韌帶、圓韌帶及輸卵管峽部進(jìn)行切斷，將闊韌帶前后葉切開，然后反折膀胱腹膜。將宮旁組織進(jìn)行有效的分離，將主韌帶、子宮動(dòng)靜脈和骶韌帶切斷，環(huán)形切開陰道壁并將子宮從陰道中去除，對(duì)陰道殘端進(jìn)行縫合，腹膜處理采取反折腹膜并關(guān)閉。開腹組患者取平臥位，取下腹部橫行切口，逐層切開，充分暴露子宮，分離雙側(cè)圓韌帶、輸卵管以及卵巢固有韌帶，分別切斷后進(jìn)行縫扎處理，將宮旁組織進(jìn)行分離，剪開膀胱反折腹膜，切斷子宮血管并進(jìn)行結(jié)扎，沿著宮頸方向向下將宮頸管組織完整切除，殘端采取連續(xù)縫。觀察并記錄兩組患者的手術(shù)時(shí)間，術(shù)中出血量，以及術(shù)后陰道殘端的出血情況。

1.4 統(tǒng)計(jì)學(xué)處理

對(duì)臨床記錄數(shù)據(jù)應(yīng)用SPSS 20.0進(jìn)行統(tǒng)計(jì)分析，計(jì)量資料進(jìn)行t檢驗(yàn)處理。若P<0.05則有差異性。

2 結(jié)果

腹腔鏡組患者手術(shù)時(shí)間為（134±13）min明顯大于開腹組手術(shù)時(shí)間為（108±9）min，術(shù)中出血量為（110±28）ml明顯低于開腹組術(shù)中出血量為（134±31）ml，陰道殘端出血量為6 ml明顯低于開腹組陰道殘端出血量為15 ml，P＜0.05，差異顯著。

3 討論

開腹手術(shù)切除子宮適用于所有需要進(jìn)行子宮切除的患者，但隨著人們生活水平的提高，解決疾病的同時(shí)，減少創(chuàng)傷也是人們衡量手術(shù)滿意度的標(biāo)準(zhǔn)之一，隨著科技的發(fā)展，腹腔鏡技術(shù)被大量應(yīng)用與婦科，腹腔鏡有著創(chuàng)傷小，出血少等優(yōu)勢(shì)，與傳統(tǒng)的手術(shù)開腹方式形成了截然的反差，但腹腔鏡手術(shù)失敗也成為開腹手術(shù)的指征 ［2-3］。本文分析腹腔鏡與開腹全子宮切除術(shù)的臨床效果。腹腔鏡組患者手術(shù)時(shí)間大于開腹組，術(shù)中出血量以及陰道殘端出血量明顯低于開腹組。綜上所述腹腔鏡手術(shù)治療全子宮切除對(duì)患者的創(chuàng)傷小，術(shù)后并發(fā)癥較少，但手術(shù)時(shí)間可能較傳統(tǒng)手術(shù)方式略長(zhǎng)。