改良腹腔镜下全子宫切除治疗大子宫肌瘤的临床疗效观察

发布时间：2018-11-04 20:36

【摘要】：目的:探讨改良腹腔镜下与开腹切除子宫治疗大子宫肌瘤在术中、术后相关指标及术后生活质量的分析比较。方法:将我院2015年1月到2017年1月符合纳入手术标准的60例,为我院妇科同一主任医师主刀的手术病例,按照手术方式分成观察组A组(改良腹腔镜下全子宫切除)33例、对照组B组(经腹全子宫切除)27例两组。比较两组的一般情况、手术时间、术中出血量、术中术后并发症率、术后肛门排气时间、术后使用镇痛药率、术后住院时间、术后病率、术后标本重量、手术费用、腹部术口愈合情况及通过采用SF-36生活质量问卷调查量表评估两组患者术后生活质量情况。结果:顺利完成33例改良腹腔镜下全子宫切除和27例经腹全子宫切除,两组平均手术时间、围手术期并发症率、腹部术口甲级愈合率、术后病率、术后标本重量差异没有统计学意义(P0.05),两组患者镇痛药使用率差异有统计学意义(P0.05);两组手术术中平均出血量、术后住院时间、手术费用、术后肛门排气时间等差异均有统计学意义(P0.05);腹腔镜组患者术后1个月SF-36生活质量得分总分平均值显著高于开腹组患者术后1个月生活质量(P0.05)。结论:1.改良腹腔镜手术能更好暴露术野、有效的闭合大血管,作为一种妇科微创手术,对于子宫增大到孕12-16周的大子宫切除在掌握其手术方法和技巧的前提下是安全、可行的。2.改良腹腔镜下行大子宫切除术与开腹手术相比有切口小、术中出血少、疼痛轻、恢复快、术后生活质量好等优势,是理想的值得推广的手术方式。
[Abstract]:Objective: to investigate the relative indexes and quality of life (QOL) in the treatment of large uterine leiomyoma by modified laparoscopy and open hysterectomy. Methods: from January 2015 to January 2017, 60 patients who met the standard of operation were divided into group A (modified laparoscopic hysterectomy) and group A (33 cases). Control group B (total abdominal hysterectomy) 27 cases of two groups. The general condition, operation time, intraoperative bleeding volume, postoperative complications rate, postoperative anus exhaust time, postoperative analgesics use rate, postoperative hospitalization time, postoperative disease rate, postoperative specimen weight, operation cost were compared between the two groups. The healing of abdominal operation and the quality of life (QOL) were evaluated by SF-36 questionnaire. Results: 33 cases of modified laparoscopic hysterectomy and 27 cases of transabdominal hysterectomy were successfully completed. There was no significant difference in the weight of postoperative specimens (P0.05), and there was significant difference in the use of painkillers between the two groups (P0.05). There were significant differences in average blood loss, postoperative hospitalization time, operation cost and postoperative anal exhaust time between the two groups (P0.05). The total score of SF-36 quality of life in the laparoscopic group was significantly higher than that in the open group 1 month after operation (P0.05). Conclusion: 1. The modified laparoscopic surgery can better expose the surgical field and close the large blood vessels effectively. As a kind of gynecologic minimally invasive surgery, it is safe to remove the large uterus from uterine enlargement to 12-16 weeks gestation under the premise of mastering the operation methods and techniques. Feasible. 2. Compared with open surgery, modified laparoscopic hysterectomy has the advantages of less incision, less bleeding, less pain, quick recovery and good quality of life. It is an ideal operative method worth popularizing.
【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

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