腹腔镜手术治疗70岁以上老年妇科良性疾病的安全性分析
发布时间：2018-07-21 12:26
【摘要】：背景随着社会的发展,老年人的比例逐年增加,其年龄界限在流行病学中以65岁为界定标准,但在临床研究中多以70岁作为老年患者筛选的下限,因为有报道称70岁以后机体各器官系统的功能明显下降,普遍被认为是机体衰老的年龄界限。随着年龄的不断增加,人体各个器官、组织和系统的功能逐渐减退,对外界应激能力也逐渐减退,对手术亦如此。随着腹腔镜技术的大量应用,在妇科领域是否可以运用于老年患者,依然存在很大争议。目的本研究通过对腹腔镜手术与传统开腹手术在治疗老年妇科良性疾病方面进行临床对比分析,探讨腹腔镜手术在治疗70岁以上老年妇科良性疾病方面是否具有安全性,为临床医生合理选择手术方式提供依据。方法回顾性分析郑州大学第一附属医院自2005年1月1日至2010年12月31日入院的年龄≥70岁诊断为妇科良性疾病行全子宫双侧附件切除术的患者,不包括子宫脱垂及阴道脱垂患者,资料完整的共计170例,分为两组,腹腔镜组90例,开腹组80例,采用SPSS21.0软件系统进行分析两组患者在年龄、术前疾病、合并症、既往盆腔手术史、术前平均住院日、手术时间、术中出血量、术中并发症、术后肛门排气时间、术后恢复正常饮食时间、术后下床活动时间、术后抗生素使用时间、术后止痛药物使用率、术后病率、术后静脉血栓形成、术后并发症、术后平均住院时间及住院总花费方面是否存在差异,以进一步了解腹腔镜手术在70岁以上老年女性患者中的安全性。结果(1)本资料共纳入的170例患者手术均顺利完成,腹腔镜手术中无一例中转开腹,成功率100%。(2)两组患者术前一般情况比较:两组患者在年龄、术前疾病分类、合并症、既往盆腔手术史及术前平均住院日的比较上无显著性统计学差异。(3)两组患者术中情况比较:腹腔镜组患者的平均手术时间(63.37±8.32)min明显少于开腹组的平均手术时间(104.20±29.91)min(t=-12.957,P=0.000);腹腔镜组术中出血量(36.78±13.93)ml明显少于开腹手术组的出血量(130.31±83.19)ml(t=-10.505,P=0.000);腹腔镜组患者术中未出现异常并发症,开腹组中有1例患者术中出血约800ml,术中给予输入悬浮红细胞4u及冰冻血浆200ml以缓解手术危机。(4)两组患者术后情况比较:腹腔镜组患者的术后肛门排气时间(1.48±0.97)d,明显少于开腹组患者的术后肛门排气时间(2.36±0.78)d(t=-6.472,P=0.000);术后恢复正常饮食时间(1.57±1.11)d,明显少于开腹组患者的术后恢复正常饮食时间(2.79±1.56)d(t=-5.931,P=0.000);术后下床活动时间(1.09±0.66)d,明显少于开腹组患者的术后下床活动时间(2.19±1.24)d(t=-6.60,P=0.000);术后抗生素使用时间(3.08±2.09)d,明显少于开腹组患者的术后抗生素使用时间(4.55±2.14)d(t=-4.534,P=0.000);腹腔镜组患者术后止痛药使用率为16.7%,明显少于开腹组患者的71.3%(χ2=2.778,P=0.096);腹腔镜手术组发生下肢静脉血栓2例(2.2%),明显少于开腹手术组患者9例(11.3%)(χ2=5.704,P=0.017);术后平均住院时间(5.70±2.51)d,明显少于开腹组患者的术后平均住院时间(8.65±3.22)d(t=-6.706,P=0.000);腹腔镜手术组患者的术后病率为4.4%,开腹组患者的术后病率11.3%,无统计学差异(χ2=2.778,P=0.096);住院总花费(24109.81±5350.06)元,明显多于开腹组患者的住院总花费(14066.75±6801.47)元(t=10.757,P=0.000);患者术后并发症:腹腔镜手术组1例患者发生肠梗阻,开腹手术组2例患者出现腹部切口愈合不良,3例患者发生肠梗阻。结论腹腔镜在70岁以上老年妇科良性疾病中行全子宫双侧附件切除术中具有创伤小、疼痛轻、恢复快、并发症少的优点,且安全性高,但费用昂贵,有待改善。
[Abstract]:Background with the development of society, the proportion of the elderly is increasing year by year. Its age limit is defined as 65 years of age in epidemiology, but in clinical research, it is used as the lower limit for the screening of elderly patients at the age of 70, because it is reported that the function of the organs of the body is obviously reduced after 70 years of age, and it is generally considered to be the age limit of the body aging. With the increase of age, the function of various organs, tissues and systems of human body has gradually diminished, and the ability to stress external stress is gradually diminished, and the operation is also the same. With the application of laparoscopic technology, there is still a lot of controversy in the field of gynaecology. In the treatment of senile gynecologic benign diseases, the clinical comparative analysis was carried out to explore the safety of laparoscopy in the treatment of benign gynecologic diseases over 70 years old, and to provide a basis for the rational selection of surgical methods by clinicians. Methods the First Affiliated Hospital of Zhengzhou University was reviewed from January 1, 2005 to 201. The patients who were admitted to hospital in December 31st, 0 years, were diagnosed as benign gynecologic diseases with total uterine bilateral adnexectomy, excluding the patients with prolapse and vaginal prolapse. The total data of 170 cases were divided into two groups, 90 cases in the laparoscopy group and 80 in the open group. The SPSS21.0 soft ware system was used to analyze the age and Preoperation disease of two groups of patients. Complications, history of previous pelvic surgery, average length of hospital stay, operation time, intraoperative bleeding, intraoperative complications, postoperative anal exhaust time, postoperative recovery of normal diet time, postoperative ambulation time, postoperative antibiotic use, postoperative analgesic drug use, postoperative morbidity, postoperative venous thrombosis, postoperative complications and postoperative leveling. Whether there was a difference in the duration of hospitalization and the total cost of hospitalization in order to further understand the safety of the laparoscopic operation in the elderly women over 70 years old. Results (1) all the 170 cases of the patients were successfully completed. There were no cases of laparotomy in laparoscopy, and the success rate of 100%. (2) two groups before operation was compared. There was no significant statistical difference between the two groups in age, preoperative disease classification, complication, history of previous pelvic surgery and the average days of hospitalization. (3) in the two groups, the average operating time (63.37 + 8.32) min in the laparoscopic group was significantly less than the average operation time (104.20 + 29.91) min (t=-12.957, P=0) in the laparotomy group. .000); the amount of bleeding (36.78 + 13.93) ml in the laparoscopy group was significantly less than that of the laparotomy group (130.31 + 83.19) ml (t=-10.505, P=0.000); there were no abnormal complications in the laparoscopy group, and 1 of the patients in the laparotomy group had intraoperative hemorrhage of 800ml. (4) the operation crisis was relieved by the infusion of suspended erythrocyte 4U and frozen plasma 200ml. (4 Comparison of the two groups after operation: the postoperative anus exhaust time (1.48 + 0.97) d in the laparoscopic group was significantly less than that of the laparotomy group (2.36 + 0.78) d (t=-6.472, P=0.000), and the normal diet time (1.57 + 1.11) d after operation was significantly less than that of the laparotomy group (2.79 + 1.56) d (t=-5 .931, P=0.000) (1.09 + 0.66) after operation (1.09 + 0.66), obviously less than the operation time (2.19 + 1.24) d (t=-6.60, P=0.000) after operation in the laparotomy group (t=-6.60, P=0.000), and the postoperative antibiotic use time (3.08 + 2.09) d, obviously less than the postoperative antibiotic use time (4.55 + 2.14) d (t=-4.534, P=0.000) of the patients with the laparotomy group (t=-4.534, P=0.000), and the postoperative pain relief in the laparoscopic group. The drug use rate was 16.7%, obviously less than 71.3% (x 2=2.778, P=0.096) in the laparotomy group; 2 cases of lower limb venous thrombosis (2.2%) in the laparoscopic operation group were less than 9 (11.3%) (11.3%) (11.3%) (5.70 + 2.51) d after the operation, and the average hospitalization time (8.65 + 3.22) d (8.65 + 3.22) d after operation was significantly less than that of the laparotomy group. T=-6.706, P=0.000); the postoperative morbidity of the patients in the laparoscopic operation group was 4.4%, the postoperative morbidity of the open group was 11.3%, no statistical difference (x 2=2.778, P=0.096); the total cost of hospitalization was (24109.81 + 5350.06) yuan (14066.75 + 6801.47) yuan (14066.75 + 6801.47) yuan (t=10.757, P=0.000), and the postoperative complications: Laparoscopic hand In the operation group, 1 patients had intestinal obstruction, 2 patients in the open operation group had abdominal wound healing and 3 patients had intestinal obstruction. Conclusion laparoscopy has the advantages of small trauma, light pain, rapid recovery, and less hair symptoms in the elderly gynecologic benign diseases over the age of 70 years old, with high safety and high cost, but expensive. To be improved.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R713
，
本文编号：2135520
[Abstract]:Background with the development of society, the proportion of the elderly is increasing year by year. Its age limit is defined as 65 years of age in epidemiology, but in clinical research, it is used as the lower limit for the screening of elderly patients at the age of 70, because it is reported that the function of the organs of the body is obviously reduced after 70 years of age, and it is generally considered to be the age limit of the body aging. With the increase of age, the function of various organs, tissues and systems of human body has gradually diminished, and the ability to stress external stress is gradually diminished, and the operation is also the same. With the application of laparoscopic technology, there is still a lot of controversy in the field of gynaecology. In the treatment of senile gynecologic benign diseases, the clinical comparative analysis was carried out to explore the safety of laparoscopy in the treatment of benign gynecologic diseases over 70 years old, and to provide a basis for the rational selection of surgical methods by clinicians. Methods the First Affiliated Hospital of Zhengzhou University was reviewed from January 1, 2005 to 201. The patients who were admitted to hospital in December 31st, 0 years, were diagnosed as benign gynecologic diseases with total uterine bilateral adnexectomy, excluding the patients with prolapse and vaginal prolapse. The total data of 170 cases were divided into two groups, 90 cases in the laparoscopy group and 80 in the open group. The SPSS21.0 soft ware system was used to analyze the age and Preoperation disease of two groups of patients. Complications, history of previous pelvic surgery, average length of hospital stay, operation time, intraoperative bleeding, intraoperative complications, postoperative anal exhaust time, postoperative recovery of normal diet time, postoperative ambulation time, postoperative antibiotic use, postoperative analgesic drug use, postoperative morbidity, postoperative venous thrombosis, postoperative complications and postoperative leveling. Whether there was a difference in the duration of hospitalization and the total cost of hospitalization in order to further understand the safety of the laparoscopic operation in the elderly women over 70 years old. Results (1) all the 170 cases of the patients were successfully completed. There were no cases of laparotomy in laparoscopy, and the success rate of 100%. (2) two groups before operation was compared. There was no significant statistical difference between the two groups in age, preoperative disease classification, complication, history of previous pelvic surgery and the average days of hospitalization. (3) in the two groups, the average operating time (63.37 + 8.32) min in the laparoscopic group was significantly less than the average operation time (104.20 + 29.91) min (t=-12.957, P=0) in the laparotomy group. .000); the amount of bleeding (36.78 + 13.93) ml in the laparoscopy group was significantly less than that of the laparotomy group (130.31 + 83.19) ml (t=-10.505, P=0.000); there were no abnormal complications in the laparoscopy group, and 1 of the patients in the laparotomy group had intraoperative hemorrhage of 800ml. (4) the operation crisis was relieved by the infusion of suspended erythrocyte 4U and frozen plasma 200ml. (4 Comparison of the two groups after operation: the postoperative anus exhaust time (1.48 + 0.97) d in the laparoscopic group was significantly less than that of the laparotomy group (2.36 + 0.78) d (t=-6.472, P=0.000), and the normal diet time (1.57 + 1.11) d after operation was significantly less than that of the laparotomy group (2.79 + 1.56) d (t=-5 .931, P=0.000) (1.09 + 0.66) after operation (1.09 + 0.66), obviously less than the operation time (2.19 + 1.24) d (t=-6.60, P=0.000) after operation in the laparotomy group (t=-6.60, P=0.000), and the postoperative antibiotic use time (3.08 + 2.09) d, obviously less than the postoperative antibiotic use time (4.55 + 2.14) d (t=-4.534, P=0.000) of the patients with the laparotomy group (t=-4.534, P=0.000), and the postoperative pain relief in the laparoscopic group. The drug use rate was 16.7%, obviously less than 71.3% (x 2=2.778, P=0.096) in the laparotomy group; 2 cases of lower limb venous thrombosis (2.2%) in the laparoscopic operation group were less than 9 (11.3%) (11.3%) (11.3%) (5.70 + 2.51) d after the operation, and the average hospitalization time (8.65 + 3.22) d (8.65 + 3.22) d after operation was significantly less than that of the laparotomy group. T=-6.706, P=0.000); the postoperative morbidity of the patients in the laparoscopic operation group was 4.4%, the postoperative morbidity of the open group was 11.3%, no statistical difference (x 2=2.778, P=0.096); the total cost of hospitalization was (24109.81 + 5350.06) yuan (14066.75 + 6801.47) yuan (14066.75 + 6801.47) yuan (t=10.757, P=0.000), and the postoperative complications: Laparoscopic hand In the operation group, 1 patients had intestinal obstruction, 2 patients in the open operation group had abdominal wound healing and 3 patients had intestinal obstruction. Conclusion laparoscopy has the advantages of small trauma, light pain, rapid recovery, and less hair symptoms in the elderly gynecologic benign diseases over the age of 70 years old, with high safety and high cost, but expensive. To be improved.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R713
，
本文编号：2135520
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