【作者】 钟树林；

【导师】 罗丽莉；

【作者基本信息】 汕头大学 ， 妇产科学， 2011， 硕士

【摘要】 目的:探讨妇科腹腔镜手术治疗的临床应用价值,并探讨腹腔镜手术相关并发症发生、处理及预防等问题。方法:回顾性分析2008年1月至2010年12月三年内因子宫肌瘤、输卵管妊娠及卵巢非恶性肿瘤在汕头大学医学院第一附属医院妇科进行手术治疗的800例患者,按照病种类型分为三大组:子宫平滑肌瘤组(UM组)、输卵管妊娠组(FP组)及卵巢非恶性肿瘤组(ONT组),而每大组内患者根据手术方式不同分为腹腔镜组与开腹组,分析对比两组患者的围手术期情况,并分析腹腔镜手术相关并发症的发生、处理及预防等问题。结果:(1)UM组内两组在手术时间、术中出血量、排气时间、术后住院天数差别均有统计学意义(P<0.05),腹腔镜组在手术时间明显长于开腹组,而术中出血量、排气时间及术后住院天数均少于开腹组。腹腔镜组中3例阔韧带肌瘤患者的手术时间较其他类型肌瘤要长,术中出血量也较多,差别有统计学意义(P<0.05)。(2)FP组中两组在各个观察指标中有显著性差异(P<0.05)。(3)ONT组内两组间差别也有统计学意义(P<0.05),腹腔镜组手术时间较开腹组长,其余指标均优于开腹组。腹腔镜手术治疗卵巢子宫内膜异位症患者较其他病理类型患者手术时间更长、术中出血量更多,差别有统计学意义(P<0.05),而排气时间及术后住院天数两者间差异无统计学意义。(4)并发症:腹腔镜治疗子宫肌瘤患者中有4例患者术后出现肩痛,占4.21%;FP组腹腔镜手术患者未发现手术相关并发症;腹腔镜治疗ONT患者中出现1例术中并发症,为结肠浆膜轻度损伤,占该组患者的0.53%;术后并发症1例,为卵巢功能早衰,占0.53%。(5)Logistic回归分析发现年龄、体重、盆腔手术史、手术方式、手术时间、术中出血量与手术相关并发症均无明显相关性(P>0.05)。结论:(1)妇科腹腔镜手术是现今微创术式,总体上较开腹手术存在其特有的优越性,具有创伤小、出血少、恢复快、住院时间短、手术切口愈合后美容效果好等特点,但术前宜权衡利弊选择腹腔镜手术治疗。(2)腹腔镜手术的广泛开展的同时,相关手术并发症也随之出现,其发生率与年龄、体重、盆腔手术史、术式、手术时间、术中出血量等因素无明显相关,可能与腔镜医生技术、经验及手术器械密切相关。更多还原

【Abstract】 Objective: To investigate the clinical applied merit of laparoscopic surgery, and probe into the causes, treatment and prevention when it comes with complications.Methods: In a prospective study, 800 cases underwent surgery because of uterine myoma, fallopian pregnancy and ovarian none-malignant tumor in the First Affiliated Hospital of Shantou University Medical College from January 2008 to December 2010. All patients were divided into three different groups depending on the different entity: the UM group, the FP group and the ONT group. And every group was separated into laparotomy group and laparoscopy group, whose preoperative conditions were analyzed. Finally, the causes, treatment and prevention were interpreted when conducting with laparoscopy.Results: (1) When Group laparoscopic myomectomy was compared with the Group laparotomy myomectomy, it had smaller amount of blood loss, shorter time of passage of gas by anus and shorter hospital stay, but significantly longer surgical time. (P<0.05).In the Group laparoscopic myomectomy, three of broad ligament myoma had longer surgical time and more amount of blood loss than the others in the same group(P<0.05).(2) There was significantly difference in the observed indicators from two surgical mode in Group FP(P<0.05). (3) In Group ONT, it also had significantly difference between laparoscopic surgery and laparotomy one(P<0.05), and laparoscopic surgery showed its advantages in some indicators but surgical time. The patients suffering endometriosis in laparoscopy group needed longer surgical time and lost more amount of blood than other ones with pathological type, and their difference had statistical significance(P<0.05),but the time of passage of gas by anus did not. (4) Complications: Four patients suffered shoulder pain after laparoscopic myomectomy, accounting for 4.21%; In Group FP, there was no complication in preoperative period; In ONT Group, there were two complications: one was mild injury of colonic mucosa, and the other was the premature ovarian failure, accounting for 0.53% as well. (5)The Logistic regress showed that the patients’age, body weight, history of pelvic surgery, surgical mode, surgical time, blood loss did not affect the incidence of complication in preoperative period(P>0.05).Conclusions: (1) Nowadays, laparoscopic surgery in gynecology had already been a minimally invasive surgery, which possessed of its superiority, such as less wound, less blood loss, faster recovery, shorter time of hospital stay and so on, but in all we should balance its pros and cons before surgery. (2) As the laparoscopic surgery was applied widely, the complication accompanied inevitably, whose incidence had no relationship with the patients’age, body weight, history of pelvic surgery, surgical mode, surgical time, blood loss and so on, maybe relating with the ability, experience of surgeons and instruments.更多还原