腹腔镜筋膜内子宫切除术改良与传统术式疗效比较

摘要

目的：探讨改良腹腔镜筋膜内子宫切除术的临床效果及安全性。方法以104例拟行腹腔镜下子宫切除术的患者为研究对象，随机分成观察组与对照组，每组52例，对照组采取传统术式的腹腔镜筋膜内子宫切除术，观察组采取改良腹腔镜筋膜内子宫切除术。比较两组患者手术时间、术中出血量、中转开腹率、术后下床时间、术后排气时间、术后3d内最高体温、住院时间、住院费用、术后并发症发生率。结果观察组手术时间及术中出血量少于对照组（t值分别为11．760、9．207，均P＜0．01），且观察组患者术后下床时间及术后排气时间均少于对照组（t值分别为27．467、17．109，均P＜0．01），观察组住院费用少于对照组（t＝2．294，P＜0．05）。两组患者中转开腹率（χ2＝0．343，P＞0．05）、术后3d内最高体温（t＝0．683，P＞0．05）、住院时间（t＝1．492，P＞0．05）及术后并发症发生率（χ2＝0．070，P＞0．05）比较均无统计学差异。结论改良腹腔镜筋膜内子宫切除术手术时间短、术中出血量少、术后下床时间及术后排气时间短，术后并发症少，安全性好，有效节约住院费用，整体效果优于传统术式。%Objective To study the clinical effect and safety of improved laparoscopic intrafascial Semm hysterectomy .Methods Totally 104 cases intending to perform classic intrafascial Semm hysterectomy ( CISH ) were recruited in the study and randomly divided into observation group and control group with 52 cases in each group . The control group adopted traditional laparoscopic intrafascial hysterectomy , while the observation group accepted improved laparoscopic intrafascial hysterectomy .Comparison was made between two groups in the aspects of operation time , intraoperative blood loss , rate of transferring to laparotomy , postoperative activity beside bed , postoperative exhaust time , highest temperature within 3 days after surgery , length of hospital stay , hospitalization expenses , and the incidence of postoperative complications .Results The operation time and bleeding amount in the observation group were obviously less than the control group (t value was 11.760 and 9.207, respectively, both P<0.01), and the time to get off bed after surgery and postoperative exhaust time were significantly less in the observation group ( t value was 27.467 and 17.109, respectively, both P <0.01).The hospitalization expenses of the observation group was obviously less (t=2.294,P<0.05).But there were no significant differences in the rate of transferring to laparotomy (χ2 =0.343, P>0.05), postoperative highest temperature within 3 days after surgery (t=0.683, P>0.683), length of hospital stay (t=1.492, P>0.05) and the incidence of postoperative complications (χ2 =0.070,P>0.05) between two groups .Conclusion Improved laparoscopic intrafascial hysterectomy has the advantages of short operation time , little intraoperative blood loss, early ambulation after surgery , short postoperative exhaust time , few postoperative complications , safety and little hospitalization cost .The whole effect of it is superior to that of conventional surgery .