腹式子宫切除术中缝合与不缝合盆底腹膜的随机研究  

Randomized study of closure or nonclosure of the pelvic peritoneum after abdominal hysterectomy

作　　者：鲁永鲜[1] 刘昕[1] 张素梅[1] 刘静霞[1] 张琳[1] 

机构地区：[1]解放军第304医院妇产科,北京100037

出　　处：《感染．炎症．修复》2001年第3期150-153,共4页Infection Inflammation Repair

摘　　要：目的:观察腹式子宫切除术中不缝合盆底腹膜对手术及术后恢复过程的影响,并探讨其优点及安全性。方法:选择181例腹式子宫切除术的病人,随机分为盆底腹膜缝合组与不缝合组(开放组)。对两组的手术时间、术中出血量、术后疼痛程度、进食时间、术后住院时间、术后病率、手术近、远期并发症进行观察比较。结果:盆底腹膜开放组较缝合组手术时间平均缩短15分钟(P<0.01),使用镇痛药次数少0.04次(P<0.01),进食时间早0.2天(P<0.05),术后住院日少2.7天(P<0.01)。两组在手术出血量,术后病率及并发症上无显著差异。术后平均随访54个月(31～77个月),两组均无远期并发症。结论:腹式子宫切除术中不缝合盆底腹膜可简化手术步骤,缩短手术及麻醉时间,不增加术后病率及近、远期并发症,而且有术后疼痛轻,肠蠕动恢复快等优点,值得临床推广应用。Objective: To determine whether nonclosure of the pelvic peritoneum after abdominal hysterectomy has advantages over suture peritonealization with regard to intraoperative or postoperative course. Methods: A prospective randomized controlled trial was performed in 181 patients who underwent abdominal hysterectomy with or without salpingo-oophorectomy. Ninety-one patients were allocated to the control 'closed' group and 90 patients to the study 'nonclosed', open group. The main items to be compared were operative time, estimated blood loss, postoperative pain, time for oral intake, length of hospital stay, febrile morbidity, and both immediate and late operative complications. Results: The mean operative time was significantly shorter by 15 minutes and the need for analgesics was fewer by 0.4 time in closed group compared with that of the open group (P<0.01). Time to oral feeding was 0.2 day earlier (P<0.05) and hospital stay was 2. 7 days less in the 'opened' group (P<0.01). Estimated blood loss, fever and postoperative complications were similar in the two groups. No late postoperative complications occurred in either group during 31-77 months of follow-up. Conclusion: Nonclosure of the visceral peritoneum after abdominal hysterectomy simplifies the surgical technique and results in shortening of -surgical time and anesthesia exposure. It has no adverse effects on the patients in regard to febrile reaction and immediate or late operative complications. Furthermore, it may decrease the administration of postoperative analgesics, allowing less complicated return of bowel function. Our study suggests that leaving the pelvic peritoneum unsutured is an acceptable way after abdominal hysterectomy.

关 键 词：腹式子宫切除术 腹膜缝合 术后病率 

分 类 号：R713[医药卫生—妇产科学]