宫颈环形电切术后再行腹腔镜下全子宫切除术的时机选择及经验总结  

The timing and experience of total laparoscopic hysterectomy after LEEP

作　　者：贾海军[1] 叶君[2] 郭海雁[1] 戴红[1] JIA Hai-jun;YE Jun;GUO Hai-yan;DAI Hong(Department of Gynecology;Department of Anesthesiology,Zhuhai Maternal and Child Health Care Hospital,Zhuhai Guangdong 519000,P.R.China)

机构地区：[1]珠海市妇幼保健院妇科,广东珠海519000 [2]珠海市妇幼保健院麻醉科,广东珠海519000

出　　处：《中国计划生育和妇产科》2018年第10期74-77,共4页Chinese Journal of Family Planning & Gynecotokology

摘　　要：目的探讨宫颈环形电切术(loop electrosurgical excision procedure,LEEP)后再行腹腔镜下全子宫切除术的时机选择对手术过程及术后并发症的影响,并总结腹腔镜下的手术技巧。方法回顾性分析珠海市妇幼保健院2012～2016年接受LEEP术后再行腹腔镜下全子宫切除的212例患者临床资料,按实施子宫切除的时机分两组:A组1周内(97例),B组4周后(115例),比较两组术中出血量、手术时间、术后住院时间、术后并发症的发生情况并分析其与手术时机选择的关系,同时总结LEEP术后腹腔镜下子宫切除的手术技巧。结果A组较B组术中出血多[(65. 32±21. 25) m L vs (58. 65±18. 31) m L],手术时间长[(103. 63±21. 16) min vs (96. 57±18. 94) min],但差异均无统计学意义(P> 0. 05);与B组比较,A组术后抗生素使用时间[(3. 23±1. 03) d vs (2. 85±0. 87) d]和住院时间[(5. 68±2. 05) d vs (4. 82±1. 86) d]均延长,且术中膀胱损伤(2. 06%vs 0)、术后盆腔或切口感染(7. 22%vs 0. 87%)及阴道残端愈合不良(5. 15%vs 0)并发症的发生率增加,差异有统计学意义(P <0. 05)。结论虽然LEEP术后宫颈外形发生改变,增加了手术难度,但术中注意手术技巧,均可顺利进行腹腔镜下全子宫切除。手术时机的选择对手术过程无明显影响,但最好选择LEEP术后4周后再次手术,以减少术后并发症,有利于加快康复。Objective To investigate the influence of the timing of total laparoscopic hysterectomy （TLH） after loop electrosurgical excision procedure（LEEP） on the surgical process and postoperative complications, and summarize the laparoscopic surgery skills. Methods 212 patients who received subsequent TLH after LEEP in Zhuhai Maternal and Child Health Care Hospital from January 2012 to December 2016 were included and retrospectively analyzed. The patients were divided into two groups according to the time interval between LEEP and TLH ： Group A （ within 1 week, n = 97） and Group B （ after 4 weeks, n = 115 ）. The volume of intraoperative blood loss, operation time, hospital stay and postoperative complications were compared between the two groups and their correlation with the timing analyzed. Meanwhile the operation skills of laparoscopic hysterectomy after LEEP were summarized. Results The intraoperative blood loss and operation time in Group A both exceeded that in Group B [ （65.32 ±21.25 ）mL vs （58. 65 ±18.3 ） mL, （ 103.63 ± 21.6） min vs （96. 57 ± 18.94） min ], but the differences were insignificant （ P 〉 0. 05 ）. Compared with Group B, the postoperative use of antibiotics and hospital stay of Group A were longer [ （ 3.23 ±1.03 ） d vs （ 2. 85 ±0. 87 ） d, （ 5.68 ± 2.05 ） d vs （4. 82± 1.86）d], and complication incidence rates of intraoperative bladder injury, postoperative infection and poor healing of vaginal stump increased（2.06 % vs 0, 7. 22 % vs 0. 87 %, 5. 15 % vs 0）, the differences were statistically significant （P 〈0. 05）. After the stratified analysis to exclude the impact of disease conditions and surgical factors, the results were consistent with the above. Conclusion Although the change of cervical shape after LEEP increased the difficulty of laparoscopic surgery, TLH can be smoothly conducted as long as fine surgical skills are applied during the operation. The timing of the operation has no obvious influence on the process of opera

关 键 词：环形电切术 全子宫切除术 腹腔镜手术 时间间隔 

分 类 号：R713.4[医药卫生—妇产科学]