3种不同术式行复杂大子宫切除术疗效及安全性对比分析  

Safety and efficacy of 3 kinds of hysterectomy for the large complicated uterus:a retrospective study

作　　者：郑果 刘亚娜 赵孟玲 付翰林 王倩[1] 毛萌[1] 郭瑞霞[1] ZHENG Guo;LIU Ya-na;ZHAO Meng-ling;FU Han-lin;WANG Qian;MAO Meng;GUO Rui-xia(Department of Gynecology,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院妇科,河南郑州450052

出　　处：《中国实用妇科与产科杂志》2023年第9期948-952,共5页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：河南省中青年卫生健康科技创新人才(领军)(YXKC2020012)。

摘　　要：目的 探讨机器人辅助腹腔镜、传统腹腔镜与开腹3种不同术式行复杂大子宫切除术的效果及安全性。方法收集2013年1月至2022年12月郑州大学第一附属医院收治的441例行复杂大子宫切除术患者的临床资料,按手术方式进行分组:传统腹腔镜手术组(腹腔镜组)273例,机器人辅助腹腔镜手术组(机器人组)105例,开腹手术组(开腹组)63例。比较3组患者的一般资料及围术期相关指标。结果 除腹腔镜组有2例中转开腹外,其余患者均顺利完成手术。手术时间机器人组[(125.2±65.6)min]短于腹腔镜组[(152.5±60.9)min]及开腹组[(150.5±66.8)min](P<0.001,P=0.012);术中出血量机器人组[(67.2±99.0)m L]少于腹腔镜组[(108.0±133.9)m L](P<0.001),且两组均少于开腹组[(238.9±242.6)m L](P<0.001,P<0.001);术后住院时间机器人组[(4.3±1.9)d]及腹腔镜组[(4.2±2.4)d]均短于开腹组[(7.6±5.3)d](P<0.001,P<0.001);术后首次肛门排气时间机器人组[(1.8±0.4)d]与腹腔镜组[(1.8±0.6)d]均短于开腹组[(2.3±0.5)d](P<0.001,P<0.001);手术并发症发生率机器人组(1.0%)低于腹腔镜组(7.3%)(P<0.017),且两组均低于开腹组(17.5%)(均P<0.017);其中,严重并发症发生率机器人组最低(P=0.038);治疗总费用(人民币)机器人组[(43143.4±8118.0)元]高于腹腔镜组[(16483.9±7225.9)元]与开腹组[(14519.6±5274.9)元](P<0.001,P<0.001)。3组患者术后24h引流量、术后留置引流管时间差异无统计学意义(P>0.05)。结论 对于复杂大子宫,相较于传统腹腔镜手术及开腹手术,机器人辅助腹腔镜手术时间短、术中出血少、并发症发生率低,虽花费昂贵,但在合理选择患者的情况下,更具优势。Objective To compare and analyze efficacy and safety of robotic-assisted laparoscopy,conventional laparoscopy and abdominal hysterectomy for the large complicated uterus.Methods Large complicated uterus is defined that uterus size judged by two deputy chief physicians or chief physicians between 12 and 20 weeks of gestation and meeting at least one of the following conditions at the same time:(1)history of pelvic and abdominal surgery≥3 times.(2)A history of endometriosis surgery or multiple hysteromyomectomy.(3)The history of intestinal obstruction or intestinal tuberculosis surgery.(4)Patients with adenomyosis and ovarian endometriosis cyst.A total of 441 patients receiving hysterectomy for complex large uterus were included in this study.Of all 441 patients,105 underwent robotic hysterectomy,273 underwent laparoscopic hysterectomy and 63 underwent abdominal hysterectomy.The baseline characteristics and peri-operative indexes were compared among the three groups.Results Except two conversions from laparoscopic to open surgery,the other operations were successfully completed.(1)Compared with the laparoscopic group(152.5±60.9)min and the abdominal group(150.5±66.8)min,the robotic group(125.2±65.6)min had the shortest operation time(P<0.001,P=0.012).(2)The estimated blood loss in the robotic group(67.2±99.0)mL was less than that in the laparoscopic group(108.0±133.9)mL(P<0.001),and both groups were less than the abdominal group(238.9±242.6)mL(P<0.001,P<0.001).(3)Postoperative hospitalization time in the robotic group(4.3±1.9)days and the laparoscopic group(4.2±2.4)days was shorter than that in the abdominal group(7.6±5.3)days(P<0.001,P<0.001).(4)The postoperative exhaust time of the robotic group(1.8±0.4)days and the laparoscopic group(1.8±0.6)days was shorter than the abdominal group(2.3±0.5)days(P<0.001,P<0.001).(5)The incidence of surgical complications was lower in the robotic group(1.0%)than in the laparoscopic group 7.3%(20/273)(P<0.017),and lower in both groups than in the laparotomy group 17.

关 键 词：复杂大子宫 传统腹腔镜手术 机器人辅助腹腔镜手术 开腹手术 

分 类 号：R713.42[医药卫生—妇产科学]