子宫颈锥形切除后再行全子宫切除对术后感染影响的临床分析  

Clinical analysis of influence of time interval between cervical conization and hysterectomy on postoperative infections

作　　者：殷新明[1] 刘颂平[1] 朱小兰[1] 温坚[1] 朱莉[1] 谈微微 

机构地区：[1]江苏大学第四附属医院暨镇江市妇幼保健院妇科,江苏镇江212001

出　　处：《中华医院感染学杂志》2016年第22期5188-5191,共4页Chinese Journal of Nosocomiology

基　　金：江苏省镇江市科技支撑计划-社会发展基金项目(SH2013088);江苏省自然科学基金项目(BK20140502)

摘　　要：目的 探讨子宫颈锥形切除术后全子宫切除的间隔时间对术后感染等因素的影响,以评估全子宫切除可行性、安全性。方法 选取医院2010年11月-2015年12月155例子宫颈锥形切除术后行全子宫切除患者,其中A组：子宫颈锥切术后48h至2周行全子宫切除;B组：子宫颈锥切术后第4、5周行全子宫切除组;C组：子宫颈锥切术后第6周及6周后行全子宫切除,回顾分析子宫颈锥切术后行全子宫切除的时间间隔对手术可行性、安全性的影响。结果 155例子宫切除患者术后感染36例,感染率23.22%,其中A组34例感染,占42.5%,36例患者术后感染中严重尿路感染2例、肠道感染3例、阴道残端感染出血二次缝合5例,全部出现在A组腹腔镜手术中;A组腹腔镜手术术后感染,与开腹手术差异有统计学意义。结论 子宫颈锥形切除术后第1-2周行全子宫切除时,术中术后并发症最高、术后感染最多,尽量避免在此阶段行全子宫切除,可待锥切4周后炎症反应消退再手术,如必须在此阶段切除子宫,尽量选择开腹全子宫切除。OBJECTIVE To explore the influence of time interval between cervical conization and hysterectomy on postoperative infection so as to evaluate the feasibility and safety of the hysterectomy .METHODS A total of 155 patients who underwent the hysterectomy after the cervical conization from Nov 2010 to Dec 2015 were enrolled in the study ;the patients who underwent the hysterectomy after the cervical conization was carried out for 48 hours to 2 weeks were assigned as the group A ,the patients who underwent the hysterectomy on week 4 ,5 after the cervical conization were set as the group B ,and the patients who underwent the hysterectomy on week 6 or after the cervical conization for 6 weeks were assigned as the group C .RESULTS The postoperative infection occurred in 36 of 155 patients undergoing the hysterectomy ,with the infection rate 23 .22% ;34 cases had the infection in the group A ,accounting for 42 .5% .Of the 36 patients with postoperative infection ,2 had severe urinary tract infec‐tion ,3 had intestinal tract infection ,5 had vaginal stump infection and were treated with second suture for bleed‐ing ,and all of infections occurred during the laparoscopic surgery .There was significant difference in the incidence of postoperative infection between the laparoscopic surgery and the laparotomy in the group A .CONCLUSION The incidence of intraoperative ,postoperative complications and postoperative infection is the highest when the hyster‐ectomy is carried out on week 1 and 2 after the cervical conization;it is necessary to avoid carrying out the hyster‐ectomy in this time period ,operate until the inflammatory reactions subside in 4 weeks after the cervical coniza‐tion ,and try to choose the laparotomy if the hysterectomy must be carried out in this time period .

关 键 词：子宫颈锥形切除术 全子宫切除术 腹腔镜子宫切除术 术后感染 时间间隔 

分 类 号：R713.42[医药卫生—妇产科学]