免气腹腔镜子宫全切术后阴道残端悬吊在临床的意义.docVIP

免气腹腔镜子宫全切术后阴道残端悬吊在临床的意义 　　【中图分类号】R734.6 【文献标识码】A 【文章编号】2095-6851（2016）11-0-01 　　【Abstract】Objective To investigate the superiority of using the vaginal stump suspension after gasless laparoscopic hysterectomy to prevent the vaginal stump prolapse after surgery. Methods from September 2014 to September 2015，168 patients who needed gasless laparoscopic hysterectomy in our hospital were divided into two groups， 88 patients from Group A had been operated on using vaginal stump suspension after gasless laparoscopic hysterectomy， and 80 patients from Group B had been operated on using vaginal stump suspension without gasless laparoscopic hysterectomy. Results The two groups in operation time， blood loss， hospital stay after operation， postoperative anal exhaust time， active time post-operation， postoperative pain have no significant difference （P0.05）. And there are significant differences between the two groups at the postoperative vaginal length changes，including the time after operation， three months after operation and six months after operation，and sexual life satisfaction score （P0.05）. Conclusion The gasless laparoscopic hysterectomy vaginal stump after suspension can prevent postoperative vaginal stump prolapse， and is simple， safe and reliable. 　　【Key words】Gas free laparoscopic Total hysterectomy the vaginal stump suspension 　　随着子宫切除的广泛应用，医源性因素作为盆腔器官脱垂（pop）的致病因素逐渐受到重视[1]，根据美国卫生统计中心（AHSC）的报告，每21例子宫切除术就有1例发生阴道穹隆脱垂，而每11例子宫切除就会有1例将来需要行阴道顶端悬吊术和阴道封闭术[2]，本院对免气腹腔镜子宫全切术后的168例患者随机分成两组，88例（A组）进行免气腹腔镜子宫全切加阴道残端悬吊，对照组80例（B组）施行免气腹腔镜子宫全切，取得满意效果，现报道如下： 　　1.临床资料 　　1.1观察对象对2014年9月至2015年9月在我院行免气腹腔镜子宫全切术后的168例患者随机分成两组，88例（A组）进行免气腹腔镜子宫全切加阴道残端悬吊，对照组80例（B组）施行免气腹腔镜子宫全切，A组其中子宫肌瘤42例，子宫腺肌症32例，功能失调性子宫出血8例，子宫内膜不典型增生6例，行子宫全切及双侧输卵管切除66例，子宫及双侧附件切除术22例，B组其中子宫肌瘤41例，子宫腺肌症28例，功能失调性子宫出血6例，子宫内膜不典型增生5例，行子宫全切及双侧输卵管切除60例，子宫及双侧附件切除术20例，患者年龄在47-58岁之间，平均年龄48.47岁，体重47kg-74kg，平均体重58..85kg。患者年龄、病种，手术史及肿瘤大小均无明显差异，两组患者选择无明显差异无统计学意义（P0.05）.术前患者常规行阴道镜检查及宫颈细胞学检查，查癌胚抗原，所有患者排除严重的心肺肝肾病变及妇科恶性肿瘤， 　　1.2手术方法： 　　1