腹腔镜下次全子宫切除术子宫动脉及宫颈残端不同处理方法的比较  

Comparison of Different Surgical Managements of the Uterine Artery and Cervical Stump during Laparoscopic Subtotal Hysterectomy

作　　者：宋改环[1] 白延青[1] 邢丽颖[1] 

机构地区：[1]宁波大学医学院附属医院妇产科,宁波315020

出　　处：《中国微创外科杂志》2012年第4期316-318,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的比较腹腔镜下次全子宫切除术子宫动脉及宫颈残端不同处理方法的临床效果。方法回顾分析我院2007年6月～2010年12月128例腹腔镜次全子宫切除术,宫颈残端缝合法65例(A组):术中缝扎子宫动静脉后,切除宫体,宫颈残端连续锁扣缝合;宫颈套扎法63例(B组):常规套扎子宫动静脉及宫颈,切除宫体后,再次套扎宫颈残端。比较2组手术时间、术中出血量、术后排气时间、术后宫颈残端出血发生率、术后住院时间、住院费用。结果 A组手术时间(63.1±14.0)min与B组(62.4±14.9)min比较无统计学差异(t=0.274,P=0.785);A组术中出血量(115.2±56.7)ml与B组(128.1±66.2)ml比较无统计学差异(t=-1.185,P=0.238);A组术后排气时间(31.1±2.7)h与B组(30.2±2.7)h比较无统计学差异(t=1.885,P=0.062);A组住院费用(14 052.8±918.1)元与B组(14 361.2±891.0)元比较无统计学差异(t=-1.928,P=0.056)。B组术后宫颈残端出血发生率6.3%(4/63)与A组0比较差异无显著性(P=0.056);B组术后住院时间(6.7±3.1)d较A组(5.8±0.5)d明显延长(t=2.310,P=0.023)。结论腹腔镜下子宫动脉+宫颈残端缝合法似较宫颈套扎法安全,减少术后宫颈残端出血并发症的发生。Objective To explore the effect of different surgical managements of the uterine artery and cervical stump during laparoscopic subtotal hysterectomy on the rate of peri-operative complications.Methods We retrospectively analyzed 128 cases of laparoscopic subtotal hysterectomy that were performed in our hospital from June 2007 to December 2010.The cases were divided into group A（n=65）,who received cervical stump suturing after the uterus being removed,and group B（n=63）,who underwent cervical stump ligation after the removal of the uterus.The operation time,intraoperative blood loss,postoperative gastrointestinal recovery time,rate of postoperative hemorrhage at the cervical stump,postoperative hospital stay,and hospital cost were compared between the two groups.Results Group B had significantly longer hospital stay than group A [（5.8±0.5） days vs.（6.7±3.1） days,t=-2.310,P=0.023].No significant difference was observed in operation time,intraoperative blood loss,postoperative gastrointestinal recovery time,hospital cost,and rate of postoperative hemorrhage between the two groups [（63.1±14.0） min vs.（62.4±14.9） min,t=0.274,P=0.785;（115.2±56.7） ml vs.（128.1±66.2） ml,t=-1.185,P=0.238;（31.1±2.7） h vs.（30.2±2.7） h,t=1.885,P=0.062;（14 052.8±918.1） RMB vs.（14 361.2±891.0） RMB,t=-1.928,P=0.056;0（0/65） vs.6.3%（4/63）,P=0.056].Conclusion Laparoscopic suturing of the uterine artery and cervical stump is safer than cervical stump ligation,and is helpful for reducing cervical stump hemorrhage after the procedure.

关 键 词：腹腔镜 次全子宫切除术 宫颈残端出血 

分 类 号：R713.42[医药卫生—妇产科学]