天津医药

天津医药 ›› 2015, Vol. 43 ›› Issue (10): 1190-1193.doi: 10.11958/j.issn.0253-9896.2015.10.028

• 应用研究 • 上一篇    下一篇

腹腔镜子宫手术并发症影响因素的分析与防治

  

  1. 天津市第三中心医院妇产科 （邮编300170）， 天津市人工细胞重点实验室
  • 收稿日期:2015-03-30 修回日期:2015-06-11 出版日期:2015-10-15 发布日期:2015-10-22

Factors of laparoscopic uterine surgery complication and its prevention

  • Received:2015-03-30 Revised:2015-06-11 Published:2015-10-15 Online:2015-10-22

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摘要：

摘要： 目的 探讨腹腔镜下子宫手术并发症发生的影响因素及预防措施。方法 行腹腔镜子宫手术患者 415
例， 分为子宫切除组 310 例和肌瘤切除组 105 例， 比较 2 组术中及术后胃肠损伤、 泌尿损伤及出血等并发症发生
率。将 415 例患者按子宫大小分为子宫体积≤300 cm（ 3 A 组），300 cm3<子宫体积<600 cm（ 3 B 组） ,子宫体积≥ 600 cm3
（C 组）。分析子宫大小、 盆腔粘连与并发症发生的关系。结果 共 23 例（5.54%）发生并发症， 其中子宫切除组
4.51% （14/310）， 肌瘤切除组 8.57% （9/105）， 差异无统计学意义 （P > 0.05）。术中或术后出血发生率为 1.93% （8/415） ,
胃肠损伤及泌尿损伤发生率均为 0.96%(8/415) 。并发症的发生率 C 组 20.0%（8/40）高于 A 组 2.8%（5/179）及 B 组
5.1%（10/196， 均 P < 0.01）， A、 B 组差异无统计学意义（P > 0.05）。盆腔粘连组发生率高于无盆腔粘连组[8.3%（15/
180）vs 3.4%（8/235）， P < 0.05]。结论 腹腔镜子宫手术并发症发生与患者的选择、 术者的经验有关， 无盆腔粘连且
子宫体积<600 cm3患者最适合行腹腔镜手术。

关键词: 腹腔镜, 外科手术, 计算机辅助, 子宫切除术, 并发症, 肌瘤切除术

Abstract:

Abstract: Objective To study the influence factors and prevention measures of complication of laparoscopic uter⁃
ine surgery. Methods Patient who underwent laparoscopic uterine surgery were collected (n=415) and divided into hyster⁃
ectomy group (n=310) and myomectomy group (n=105). Intraoperative and postoperative complications such as gastrointesti⁃
nal injury, urinary injury and bleeding were recorded and compared between these two groups. Base on their uterine size, pa⁃
tients were divided into Group A (uterine volume ≤300 cm3), Group B (300 cm3 <uterine volume <600 cm3) and Group C
(uterine volume ≥ 600 cm3). Correlation between uterine size or pelvic adhesions with complications are investigated. Re⁃
sults A total of 23 patients (5.54%) were with complications. Complication occurrence in hysterectomy group was 4.51%
(14/310) and in myomectomy group was 8.57% (9/105) . The difference was not statistically significant (P > 0.05). The inci⁃
dence of intraoperative or postoperative bleeding was 1.93% (8/415) and incidence of gastrointestinal damage or urinary inju⁃
ry rate was 0.96% (8/415). The incidence of complications in group C was 20.0% (8/40) which is higher than that in group A
(2.8%; 5/179) and group B (5.1% ; 10/196). P < 0.01 in all cases. The difference between group A and group B was not signif⁃
icant (P > 0.05). The incidence in pelvic adhesions group is higher than that in the group without pelvic adhesions [8.3% (15/
180) vs 3.4% (8/235), P < 0.05]. Conclusion The incidence of complications in laparoscopic myomectomy was higher than
that in laparoscopic hysterectomy. When patients were without pelvic adhesions or with uterine volume < 600 cm3, laparo⁃
scopic surgery present least complication.

Key words: laparoscopy, surgery, computer-assisted , hysterectomy, concurrent disease, muscular tumor excision