本文關(guān)鍵詞： 腹腔鏡全子宮切除術(shù) 術(shù)后病率 并發(fā)癥　出處：《大連醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：探討我院腹腔鏡全子宮切除術(shù)的術(shù)后病率及并發(fā)癥的相關(guān)影響因素。 方法：回顧性總結(jié)大連市婦產(chǎn)醫(yī)院2012年12月-2013年12月，402例腹腔鏡單純?nèi)訉m切除術(shù)的臨床資料，采用χ2檢驗(yàn)比較有錐切史與無錐切史患者、錐切相隔時間短與錐切相隔時間長、有陰道炎與無陰道炎患者術(shù)后病率是否有差異，采用單因素Logistic回歸分析患者年齡、體重指數(shù)、子宮大小、手術(shù)史、子宮內(nèi)膜異位癥病史等與腹腔鏡全子宮切除手術(shù)并發(fā)癥發(fā)生的關(guān)系。 結(jié)果：402例患者均于腹腔鏡下完成手術(shù),無一例中轉(zhuǎn)開腹。手術(shù)平均時間為(89.51±24.55)min，術(shù)后血紅蛋白平均改變量(-6.88±5.81)g/L，術(shù)后最高體溫平均(37.5±0.4)℃，術(shù)后住院天數(shù)平均(5.2±2.1)d,術(shù)后病率為5.72%，并發(fā)癥發(fā)生率為：3.98%。χ2檢驗(yàn)結(jié)果顯示有錐切史與無錐切史的患者術(shù)后病率比較差異有統(tǒng)計(jì)學(xué)意義（χ2=19.535，P=0.000），錐切相隔時間短與錐切相隔時間長的患者術(shù)后病率比較差異無統(tǒng)計(jì)學(xué)意義（χ2=2.463，P=0.117)，有陰道炎的患者與無陰道炎的患者術(shù)后病率比較差異有統(tǒng)計(jì)學(xué)意義（χ2=10.416，P=0.001）。穿刺及氣腹相關(guān)的并發(fā)癥2例，發(fā)生率為：0.5%，占總并發(fā)癥的12.5%：均為腹壁血管損傷。術(shù)中并發(fā)癥4例，發(fā)生率為：1%，占總并發(fā)癥的25%：失血過多2例、輸尿管損傷1例、腸管損傷1例。術(shù)后并發(fā)癥10例，發(fā)生率為：2.49%，，占總并發(fā)癥的62.5%：腸梗阻2例、腹腔內(nèi)出血1例、陰道殘端出血4例、盆腔膿腫3例。我院腹腔鏡全子宮切除手術(shù)并發(fā)癥以術(shù)后并發(fā)癥最多見。單因素Logistic回歸分析顯示，患者年齡（OR=1.404，P=0.490）、體重指數(shù)（OR=1.631，P=0.345）、子宮大小（OR=1.294，P=0.302）、手術(shù)史（OR=2.408，P=0.099）與腹腔鏡全子宮切除手術(shù)并發(fā)癥發(fā)生無關(guān)，子宮內(nèi)膜異位癥病史(OR=6.564,P=0.001)與并發(fā)癥發(fā)生有關(guān)。 結(jié)論： 1.我院2012年12月-2013年12月腹腔鏡全子宮切除術(shù)，術(shù)后病率發(fā)生率為5.72%，并發(fā)癥發(fā)生率為3.98%，以術(shù)后并發(fā)癥多見。 2.有錐切史患者術(shù)后病率與無錐切史患者術(shù)后病率不同，有錐切史患者高于無錐切史患者。 3.錐切相隔時間短與錐切相隔時間長的術(shù)后病率比較，差異無統(tǒng)計(jì)學(xué)意義,尚不能認(rèn)為兩組術(shù)后病率有差異。 4.有陰道炎的患者術(shù)后病率與無陰道炎的患者術(shù)后病率不同，有陰道炎的患者高于無陰道炎的患者。 5.患者年齡、體重指數(shù)、子宮大小、手術(shù)史與腹腔鏡全子宮切除手術(shù)并發(fā)癥發(fā)生無關(guān)。 6.子宮內(nèi)膜異位癥病史與腹腔鏡全子宮切除手術(shù)并發(fā)癥相關(guān)，是腹腔鏡全子宮切除手術(shù)并發(fā)癥發(fā)生的危險(xiǎn)因素。
[Abstract]:Objective: To explore the related factors of postoperative morbidity and complications of laparoscopic total hysterectomy in our hospital.
Methods: a retrospective analysis of Dalian City maternity hospital in December 2012 -2013 year in December, the clinical data of 402 cases of laparoscopic hysterectomy, 2 test was used in comparison with conization history and no history of conization patients, conization interval and short cut cone separated by a long time, there is no patients with vaginitis vaginitis disease rate whether there are differences, using single factor Logistic regression analysis with age, body mass index, uterine size, surgical history, endometriosis history and laparoscopic hysterectomy surgery related complication.
Results: 402 patients completed surgery in laparoscopic, no cases were converted to laparotomy. The average operative time was (89.51 + 24.55) min, postoperative hemoglobin change (-6.88 + 5.81) g/L, postoperative highest temperature average (37.5 + 0.4) C, average hospitalization days after operation (5.2 + 2.1) d, postoperative disease rate was 5.72%, the complication rate was: 3.98%. x 2 test results showed that conization history and no history of conization postoperative disease rate difference was statistically significant (2=19.535, P=0.000), separated by short time and conization conization disease rate had no significant difference between the time long after surgery (2=2.463, P=0.117), the patients with vaginitis vaginitis patients with postoperative disease rate difference was statistically significant (2=10.416, P=0.001). 2 cases of complications of puncture and pneumoperitoneum related, the incidence rate was 0.5%, total: 12.5%: complications were abdominal vascular injury during the operation. 4 cases of complications, the incidence was 1%, the total complication 25%: excessive bleeding in 2 cases, 1 cases of ureteral injury, 1 cases of intestinal injury. 10 cases of postoperative complications, the incidence rate was 2.49%, total 62.5% complications: 2 cases of intestinal obstruction, abdominal bleeding in 1 cases, 4 cases of vagina stump hemorrhage, 3 cases of pelvic abscess in our hospital. Total laparoscopic hysterectomy in the complications of postoperative complications. The most common single factor Logistic regression analysis showed that age (OR=1.404, P=0.490), body mass index (OR=1.631, P=0.345), the size of the uterus (OR=1.294, P=0.302), surgery (OR=2.408, P=0.099) and laparoscopic Panhysterectomy complications unrelated to endometriosis history (OR=6.564, P=0.001) associated with complications.
Conclusion:
1. laparoscopic total hysterectomy in December -2013 December 2012, the incidence of postoperative morbidity was 5.72%, the incidence of complications was 3.98%, with postoperative complications.
2. the incidence of postoperative disease in patients with conical cutting history was different from that of the patients without conical cutting history. The patients with conical history were higher than those without the history of cone cutting history.
There was no statistically significant difference in the postoperative morbidity of 3. conical cut intervals and the length of the conical cutting interval, and there was no difference between the two groups after operation.
4. the incidence of postoperative disease in patients with vaginitis is different from that of the patients without vaginitis, and the patients with vaginitis are higher than those without vaginitis.
5. the age, body mass index, the size of the uterus, the history of the operation were not related to the complications of the laparoscopic total hysterectomy.
6. the history of endometriosis is associated with complications of laparoscopic total hysterectomy, which is a risk factor for the complications of laparoscopic total hysterectomy.

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R713.42

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