腹腔镜子宫手术并发症影响因素的分析与防治  

Factors of laparoscopic uterine surgery complication and its prevention

作　　者：王海芳[1] 李强[1] 张爱华[1] 姚爱琳[1] 

机构地区：[1]天津市第三中心医院妇产科,天津市人工细胞重点实验室,天津300170

出　　处：《天津医药》2015年第10期1190-1193,共4页Tianjin Medical Journal

摘　　要：目的探讨腹腔镜下子宫手术并发症发生的影响因素及预防措施。方法行腹腔镜子宫手术患者415例,分为子宫切除组310例和肌瘤切除组105例,比较2组术中及术后胃肠损伤、泌尿损伤及出血等并发症发生率。将415例患者按子宫大小分为子宫体积≤300 cm3(A组),300 cm3<子宫体积<600 cm3(B组),子宫体积≥600 cm3(C组)。分析子宫大小、盆腔粘连与并发症发生的关系。结果共23例(5.54%)发生并发症,其中子宫切除组4.51%(14/310),肌瘤切除组8.57%(9/105),差异无统计学意义(P>0.05)。术中或术后出血发生率为1.93%(8/415),胃肠损伤及泌尿损伤发生率均为0.96%(8/415)。并发症的发生率C组20.0%(8/40)高于A组2.8%(5/179)及B组5.1%(10/196,均P<0.01),A、B组差异无统计学意义(P>0.05)。盆腔粘连组发生率高于无盆腔粘连组[8.3%(15/180)vs 3.4%(8/235),P<0.05]。结论腹腔镜子宫手术并发症发生与患者的选择、术者的经验有关,无盆腔粘连且子宫体积<600 cm3患者最适合行腹腔镜手术。Objective To study the influence factors and prevention measures of complication of laparoscopic uter-ine surgery. Methods Patient who underwent laparoscopic uterine surgery were collected （n=415） and divided into hyster-ectomy group （n=310） and myomectomy group （n=105）. Intraoperative and postoperative complications such as gastrointesti-nal injury, urinary injury and bleeding were recorded and compared between these two groups. Base on their uterine size, pa-tients were divided into Group A （uterine volume ≤300 cm3）, Group B （300 cm3 〈uterine volume 〈600 cm3） and Group C （uterine volume ≥ 600 cm3）. Correlation between uterine size or pelvic adhesions with complications are investigated. Re-sults A total of 23 patients （5.54%） were with complications. Complication occurrence in hysterectomy group was 4.51%（14/310） and in myomectomy group was 8.57%（9/105） . The difference was not statistically significant （P〉0.05）. The inci-dence of intraoperative or postoperative bleeding was 1.93%（8/415） and incidence of gastrointestinal damage or urinary inju-ry rate was 0.96%（8/415）. The incidence of complications in group C was 20.0%（8/40） which is higher than that in group A （2.8%;5/179） and group B （5.1%;10/196）. P〈0.01 in all cases. The difference between group A and group B was not signif-icant （P〉0.05）. The incidence in pelvic adhesions group is higher than that in the group without pelvic adhesions [8.3%（15/180） vs 3.4%（8/235）, P〈0.05]. Conclusion The incidence of complications in laparoscopic myomectomy was higher than that in laparoscopic hysterectomy. When patients were without pelvic adhesions or with uterine volume〈 600 cm3, laparo-scopic surgery present least complication.

关 键 词：腹腔镜 外科手术 计算机辅助 子宫切除术 并发症 肌瘤切除术 

分 类 号：R713.4[医药卫生—妇产科学]