腹腔镜单纯全子宫切除402例术后病率及并发症分析

发布时间：2018-01-19 14:41

本文关键词： 腹腔镜全子宫切除术术后病率并发症　出处：《大连医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：探讨我院腹腔镜全子宫切除术的术后病率及并发症的相关影响因素。方法：回顾性总结大连市妇产医院2012年12月-2013年12月，402例腹腔镜单纯全子宫切除术的临床资料，采用χ2检验比较有锥切史与无锥切史患者、锥切相隔时间短与锥切相隔时间长、有阴道炎与无阴道炎患者术后病率是否有差异，采用单因素Logistic回归分析患者年龄、体重指数、子宫大小、手术史、子宫内膜异位症病史等与腹腔镜全子宫切除手术并发症发生的关系。结果：402例患者均于腹腔镜下完成手术,无一例中转开腹。手术平均时间为(89.51±24.55)min，术后血红蛋白平均改变量(-6.88±5.81)g/L，术后最高体温平均(37.5±0.4)℃，术后住院天数平均(5.2±2.1)d,术后病率为5.72%，并发症发生率为：3.98%。χ2检验结果显示有锥切史与无锥切史的患者术后病率比较差异有统计学意义（χ2=19.535，P=0.000），锥切相隔时间短与锥切相隔时间长的患者术后病率比较差异无统计学意义（χ2=2.463，P=0.117)，有阴道炎的患者与无阴道炎的患者术后病率比较差异有统计学意义（χ2=10.416，P=0.001）。穿刺及气腹相关的并发症2例，发生率为：0.5%，占总并发症的12.5%：均为腹壁血管损伤。术中并发症4例，发生率为：1%，占总并发症的25%：失血过多2例、输尿管损伤1例、肠管损伤1例。术后并发症10例，发生率为：2.49%，，占总并发症的62.5%：肠梗阻2例、腹腔内出血1例、阴道残端出血4例、盆腔脓肿3例。我院腹腔镜全子宫切除手术并发症以术后并发症最多见。单因素Logistic回归分析显示，患者年龄（OR=1.404，P=0.490）、体重指数（OR=1.631，P=0.345）、子宫大小（OR=1.294，P=0.302）、手术史（OR=2.408，P=0.099）与腹腔镜全子宫切除手术并发症发生无关，子宫内膜异位症病史(OR=6.564,P=0.001)与并发症发生有关。结论： 1.我院2012年12月-2013年12月腹腔镜全子宫切除术，术后病率发生率为5.72%，并发症发生率为3.98%，以术后并发症多见。 2.有锥切史患者术后病率与无锥切史患者术后病率不同，有锥切史患者高于无锥切史患者。 3.锥切相隔时间短与锥切相隔时间长的术后病率比较，差异无统计学意义,尚不能认为两组术后病率有差异。 4.有阴道炎的患者术后病率与无阴道炎的患者术后病率不同，有阴道炎的患者高于无阴道炎的患者。 5.患者年龄、体重指数、子宫大小、手术史与腹腔镜全子宫切除手术并发症发生无关。 6.子宫内膜异位症病史与腹腔镜全子宫切除手术并发症相关，是腹腔镜全子宫切除手术并发症发生的危险因素。
[Abstract]:Objective: To explore the related factors of postoperative morbidity and complications of laparoscopic total hysterectomy in our hospital.
Methods: a retrospective analysis of Dalian City maternity hospital in December 2012 -2013 year in December, the clinical data of 402 cases of laparoscopic hysterectomy, 2 test was used in comparison with conization history and no history of conization patients, conization interval and short cut cone separated by a long time, there is no patients with vaginitis vaginitis disease rate whether there are differences, using single factor Logistic regression analysis with age, body mass index, uterine size, surgical history, endometriosis history and laparoscopic hysterectomy surgery related complication.
Results: 402 patients completed surgery in laparoscopic, no cases were converted to laparotomy. The average operative time was (89.51 + 24.55) min, postoperative hemoglobin change (-6.88 + 5.81) g/L, postoperative highest temperature average (37.5 + 0.4) C, average hospitalization days after operation (5.2 + 2.1) d, postoperative disease rate was 5.72%, the complication rate was: 3.98%. x 2 test results showed that conization history and no history of conization postoperative disease rate difference was statistically significant (2=19.535, P=0.000), separated by short time and conization conization disease rate had no significant difference between the time long after surgery (2=2.463, P=0.117), the patients with vaginitis vaginitis patients with postoperative disease rate difference was statistically significant (2=10.416, P=0.001). 2 cases of complications of puncture and pneumoperitoneum related, the incidence rate was 0.5%, total: 12.5%: complications were abdominal vascular injury during the operation. 4 cases of complications, the incidence was 1%, the total complication 25%: excessive bleeding in 2 cases, 1 cases of ureteral injury, 1 cases of intestinal injury. 10 cases of postoperative complications, the incidence rate was 2.49%, total 62.5% complications: 2 cases of intestinal obstruction, abdominal bleeding in 1 cases, 4 cases of vagina stump hemorrhage, 3 cases of pelvic abscess in our hospital. Total laparoscopic hysterectomy in the complications of postoperative complications. The most common single factor Logistic regression analysis showed that age (OR=1.404, P=0.490), body mass index (OR=1.631, P=0.345), the size of the uterus (OR=1.294, P=0.302), surgery (OR=2.408, P=0.099) and laparoscopic Panhysterectomy complications unrelated to endometriosis history (OR=6.564, P=0.001) associated with complications.
Conclusion:
1. laparoscopic total hysterectomy in December -2013 December 2012, the incidence of postoperative morbidity was 5.72%, the incidence of complications was 3.98%, with postoperative complications.
2. the incidence of postoperative disease in patients with conical cutting history was different from that of the patients without conical cutting history. The patients with conical history were higher than those without the history of cone cutting history.
There was no statistically significant difference in the postoperative morbidity of 3. conical cut intervals and the length of the conical cutting interval, and there was no difference between the two groups after operation.
4. the incidence of postoperative disease in patients with vaginitis is different from that of the patients without vaginitis, and the patients with vaginitis are higher than those without vaginitis.
5. the age, body mass index, the size of the uterus, the history of the operation were not related to the complications of the laparoscopic total hysterectomy.
6. the history of endometriosis is associated with complications of laparoscopic total hysterectomy, which is a risk factor for the complications of laparoscopic total hysterectomy.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R713.42

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