【作者】 冯怡辰；

【导师】 马彩玲；

【作者基本信息】 新疆医科大学 ， 妇产科， 2009， 硕士

【摘要】 目的:利用手术难度评分系统预测腹腔镜下子宫肌瘤剔除术(Laparoscopic myomectomy,LM)结局的可行性分析。方法:对新疆医科大学第一附属医院妇科2007.6-2008.12年收治的符合纳入标准的183例腹腔镜下子宫肌瘤剔除术的临床资料使用手术难度评分系统进行逐个评分,按评分结果与手术时间、术前术后血红蛋白(hemoglobin,HB)差值、术后肠功能恢复时间行相关分析,若相关,则依据评分结果将患者分为3组:第一组<5分;第二组≥5分,<8分;第三组≥8分,比较三组之间手术时间,术前术后HB差值及术后肠功能恢复时间有无差异。结果:根据统计显示,累计得分与手术时间、术前术后HB差值、术后肠功能恢复时间的r值分别0.661、0.521、0.307,均为正相关,前两者呈密切相关。而后者相关不密切。3组之间手术时间及术前术后HB差值均显示差异有统计学意义(P<0.05)。3组间两两比较结果显示,1、2组的手术时间和第3组之间差异有统计学意义(P均小于0.05)。1、2组的术前术后HB差值和第3组差异之间有统计学意义(P均小于0.05)。术后肠功能恢复时间1组与2组之间差异有统计学意义(P<0.05)。3组和1组、2组之间差异无统计学意义,P值分别为0.05,0.356。比较3组患者90min内完成手术的情况。差异有统计学意义(P<0. 05)。再次进行3组间两两比较,结果为: 1组和2组、第3组之间均有显著差异,P均<0.05。2、3组之间差异无统计学意义,P=0.0176(两两比较P<0. 017有统计学意义)。结论:手术难度评分系统对预测腹腔镜下子宫肌瘤剔除术的结局有一定的指导意义。手术难度评分分值集中分布在8分以下,随着手术难度评分的增加,手术时间延长,手术难度增加,术前术后HB差值也随之增加。手术难度≥8分时,手术较困难,手术时间明显延长,必要时可依据自身的手术技巧,选择手术方式。必要时果断地采取中转开腹手术,可降低手术难度,缩短手术时间,减少出血量,最大限度的减少创伤。更多还原

【Abstract】 Objective: To make use of surgical difficulty prediction scoring system laparoscopic myomectomy (Laparoscopic myomectomy, LM) the outcome of the feasibility analysis. Methods: The First Affiliated Hospital of Xinjiang Medical University 2007.6-2008.12 gynecological hospital in line with the standard of the 183 cases of laparoscopic myomectomy surgery clinical data of the difficulty of scoring system used to carry out one by one score, according to score the results and the operative time, preoperative and postoperative hemoglobin (hemoglobin, HB) the margin, postoperative intestinal function recovery time line analysis, if relevant, the score based on the results of patients were divided into 3 groups: the first <5 scores; second group≥5 scores , <8 scores; The third group of≥8 scores, compared operative time among the three groups, preoperative and postoperative difference between HB and postoperative intestinal function recovery time whether the differences. Results: According to statistics, a total score and operative time, preoperative and postoperative difference between HB postoperative intestinal function recovery time of r = 0.661,0.521,0.307, are positively correlated, the former two were closely related. While the latter is not closely related. Operation time between group 3 and the difference between preoperative and postoperative HB show statistically significant difference (P <0.05). 22 among the 3 groups the results of the comparison showed that the operative time groups 1,2 and 3 groups were statistically significant differences (P <0.05). 1,2 Group HB difference before and after operation and the difference between the 3 groups was statistically significant (P <0.05). Postoperative intestinal function recovery time 1 group and the difference between the 2 groups was statistically significant (P <0.05). 3 group and one group, the difference between the 2 groups was not significant, P = 0.05,0.356. Group 3 patients with comparative 90min to complete the surgery. There were significant differences (P <0. 05). Re-22 3 group compared with the results as follows: Group 1 and Group 2, Group 3 were significant differences between, P all <0.05. 2,3 group was no significant difference between, P = 0.0176 (two Comparing the two P <0. 017 there is statistical significance). Conclusion: The surgical scoring system for predicting difficult laparoscopic myomectomy must have the outcome of the guide. Score the difficulty of the operation focused on the distribution of scores at 8 am the following, with the score of the increase in the difficulty of surgery, surgical time, increased difficulty of surgery, preoperative and postoperative margin also increased HB.≥8 timeshare operation difficult, more difficult surgery, prolonged operative time and, if necessary, surgery can be the basis of their skills, select the operation mode. If necessary, to take decisive conversion surgery, surgery to reduce the difficulty and shorten the operation time to reduce the amount of bleeding, to minimize trauma.更多还原