妇科腹腔镜手术中转开腹84例临床分析  

Clinical analysis of 84 cases of conversion from gynecologic laparoscopic surgery to laparotomy

作　　者：郭慧丹 季嵘 刘昱 爨晨晓 戴红英[1] Guo Huidan;Ji Rong;Liu Yu;Cuan Chenxiao;Dai Hongying(Department of Gynecology,Affiliated Hospital of Qingdao University,Qingdao 266100)

机构地区：[1]青岛大学附属医院,青岛266100

出　　处：《中国综合临床》2022年第6期548-553,共6页Clinical Medicine of China

摘　　要：目的分析腹腔镜手术中转开腹的原因及其影响因素。方法对青岛大学附属医院妇科2017年8月至2020年8月16203例腹腔镜手术中84例中转开腹患者的临床资料进行回顾性分析,每例中转开腹患者选取2例单纯腹腔镜手术患者进行对照匹配,将患者分为中转开腹组(84例)和对照组(168例),并分析腹腔镜中转开腹影响因素。计数资料组间比较采用χ^(2)检验或校正的χ^(2)检验或Fisher确切概率法。病例对照设计的多因素分析采用条件Logistic回归分析。结果妇科腹腔镜手术中转开腹率0.52%(84/16203)。84例腹腔镜手术中转开腹手术原因依次为:盆腔粘连50.0%(42/84),未预计恶性肿瘤19.0%(16/84),肿瘤过大或形态、位置特殊14.3%(12/84),止血困难7.1%(6/84),子宫肌瘤多发3.5%(3/84),需同时行外科手术3.5%(3/84),膀胱损伤1.2%(1/84),术中发生皮下气肿1.2%(1/84)。两组患者体质量指数、合并症(糖尿病、高血压、冠心病、甲状腺疾病史)比较差异均无统计学意义(均P>0.05);中转开腹组患者子宫内膜异位症病史36.9%(31/84)、盆腹腔手术史占比60.7%(51/84)高于对照组[20.8%(35/84)、30.6%(51/84)](χ^(2)=7.482、21.42,P=0.006)。条件Logistic回归分析提示:手术史(OR=3.979,95%CI 2.010~7.874,P<0.001)、甲状腺病史(OR=15.333,95%CI 1.087~216.346,P=0.005)增加中转开腹风险;高血压病史(OR=0.203,95%CI 0.067~0.622,P=0.005)降低中转开腹风险。进一步分析哪种手术类型影响中转开腹,发现剖宫产术(OR=2.105,95%CI 1.109~4.351,P=0.044)、子宫肌瘤剔除术(OR=11.605,95%CI 3.306~40.735,P<0.001)、卵巢囊肿剥除术(OR=7.914,95%CI 2.157~21.037,P=0.002)对中转开腹有影响。结论妇科腹腔镜手术中转开腹的主要原因为盆腔粘连,手术史、甲状腺病史是中转开腹的危险因素,其中子宫肌瘤剔除术、卵巢囊肿剥除术是导致中转开腹的重要因素。术前应结合患者的病史和病情,选择合适的临床术式,保证患者的�Objective To analyze the causes and influencing factors of conversion from laparoscopic surgery to laparotomy.Methods To analyze and summarize the clinical data of 84 patients who converted to laparotomy in 16203 cases of laparoscopic surgery from August 2017 to August 2020 in the Department of Gynecology of the Affiliated Hospital of Qingdao University,each patient converted to surgery was matched with 2 patients who underwent simple laparoscopic surgery.The patients were divided into conversion to laparotomy group(84 cases)and control group(168)cases,and analyze the influencing factors of laparoscopic conversion to laparotomy.χ^(2) test or correctedχ^(2) test or Fisher exact probability method were used for the comparison of counting data between groups,and conditional regression analysis was used for the multivariate analysis of case control design.Results The conversion rate of gynecologic laparoscopic surgery to laparotomy was 0.52%(84/16203).The reasons for 84 cases of conversion from laparoscopic surgery to open surgery were as follows:pelvic adhesion 50.0%(42/84),unexpected malignant tumor 19.0%(16/84),tumor oversize or special shape and location 14.3%(12/84),hemostasis difficulty 7.1%(6/84),multiple uterine fibroids 3.5%(3/84),simultaneous surgery 3.5%(3/84),bladder injury 1.2%(1/84),and subcutaneous emphysema 1.2%(1/84)during the operation.There were no significant differences in body mass index and comorbidities(diabetes,hypertension,coronary heart disease,thyroid disease)between the two groups(all P>0.05).And the history of endometriosis was 36.9%(31/84)and the history of pelvic surgery in the transperitoneal group was 60.7%(51/84)higher than that in the conversion to laparotomy group of 20.8%(35/84),30.6%(51/84)(χ^(2)=7.482,21.42,P=0.006).The results of conditional regression analysis showed that that surgical history(OR=3.979,95%CI 2.010-7.874,P<0.001 and thyroid history(OR=15.333,95%CI 1.087-216.346,P=0.005)increased the risk of conversion to laparotomy;Hypertension history(OR=0.203,95%CI 0.067-

关 键 词：妇科 腹腔镜手术 开腹手术 

分 类 号：R713[医药卫生—妇产科学]