全子宫切除术后阴道断端裂开:病例分析及文献回顾  

Vaginal cuff dehiscence after hysterectomy:case analysis and literature review

作　　者：杨艳[1] 李萌[1] 梁华茂[1] 吴郁[1] 郭红燕[1] 韩劲松[1] 张坤[1] Yang Yan;Li Meng;Liang Huamao(Department of Obstetrics and Gynecology,Peking University Third Hospital,National Clinical Research Center for Obstetrics and Gynecology,Beijing 100191)

机构地区：[1]北京大学第三医院妇产科,国家妇产疾病临床医学研究中心,北京100191

出　　处：《现代妇产科进展》2022年第6期407-411,共5页Progress in Obstetrics and Gynecology

摘　　要：目的分析全子宫切除术后阴道断端裂开的病例特点,识别高危因素、探索治疗方法。方法回顾分析北京大学第三医院妇产科2009年至2021年行全子宫切除或广泛/次广泛子宫切除术后发生阴道断端裂开的18例患者的临床资料,对其术前临床特征、手术参数、术后发病时间、诱发因素、症状、脱出脏器特征及修复方式进行描述。结果阴道断端裂开发病率为0.2%(18/8929),患者平均年龄(47.1±7.5)岁,平均体质量指数(BMI)(21.4±2.0)kg/m^(2)。前次手术为腹腔镜手术15例、开腹手术3例。手术指征为恶性肿瘤15例、癌前病变1例、良性疾病2例。中位发病时间128.5d。发病诱因包括性生活8例、经阴道超声检查3例、排便困难3例、无明显诱因4例。经阴式修复11例、腹腔镜修复5例、开腹1例、腹腔镜+阴式1例。4例患者同时行部分大网膜切除术。结论全子宫切除术后阴道断端裂开多发生在恶性肿瘤患者术后,主要诱发因素为性生活及经阴道超声检查,多数可经阴式修复。Objective:To analyze the characteristics of clinical parameters,identify the risk factors,and explore surgical management options.Methods:We retrospectively analyzed the clinical parameters of vaginal cuff dehiscence cases after hysterectomy,radical or sub-radical hysterectomy,including the perioperative factors,operation data,postoperative onset time,trigger factors,symptoms,the presentation of evisceration,and the methods of surgical repair.Results:The rate of vaginal cuff dehiscence in this study was 0.2%(18/8929).The mean age of the 18 patients was(47.1±7.5)years,and the mean body mass index was(21.4±2.0)kg/m^(2).15 patients occurred after laparoscopic hysterectomy,and 3 after abdominal hysterectomy.15 cases received operations for malignant indications,1 for cervical intraepithelial neoplasia,and 2 for benigns.The median postoperative onset time was 128.5 days.The precipitating events included sexual intercourse(8 cases),vaginal ultrasonography examination(3 cases),difficult defecation(3 cases),and not inducement(4 cases).11 of dehiscences were repaired vaginally,5 were repaired laparoscopically,1 was repaired abdominally,and 1 was repaired with a combined approach(laparoscopic and vaginal).4 patients received partial omentum resection simultaneously.Conclusion:Vaginal cuff dehiscence after hysterectomy mostly occurs in malignant tumor patients.The main trigger event is to be considered as sexual intercourse and vaginal ultrasonography examination,and most of cases are repaired by vaginally.

关 键 词：全子宫切除术 阴道断端裂开 高危因素 

分 类 号：R713[医药卫生—妇产科学]