【摘要】：背景隨著社會(huì)的發(fā)展,老年人的比例逐年增加,其年齡界限在流行病學(xué)中以65歲為界定標(biāo)準(zhǔn),但在臨床研究中多以70歲作為老年患者篩選的下限,因?yàn)橛袌?bào)道稱70歲以后機(jī)體各器官系統(tǒng)的功能明顯下降,普遍被認(rèn)為是機(jī)體衰老的年齡界限。隨著年齡的不斷增加,人體各個(gè)器官、組織和系統(tǒng)的功能逐漸減退,對(duì)外界應(yīng)激能力也逐漸減退,對(duì)手術(shù)亦如此。隨著腹腔鏡技術(shù)的大量應(yīng)用,在婦科領(lǐng)域是否可以運(yùn)用于老年患者,依然存在很大爭(zhēng)議。目的本研究通過(guò)對(duì)腹腔鏡手術(shù)與傳統(tǒng)開腹手術(shù)在治療老年婦科良性疾病方面進(jìn)行臨床對(duì)比分析,探討腹腔鏡手術(shù)在治療70歲以上老年婦科良性疾病方面是否具有安全性,為臨床醫(yī)生合理選擇手術(shù)方式提供依據(jù)。方法回顧性分析鄭州大學(xué)第一附屬醫(yī)院自2005年1月1日至2010年12月31日入院的年齡≥70歲診斷為婦科良性疾病行全子宮雙側(cè)附件切除術(shù)的患者,不包括子宮脫垂及陰道脫垂患者,資料完整的共計(jì)170例,分為兩組,腹腔鏡組90例,開腹組80例,采用SPSS21.0軟件系統(tǒng)進(jìn)行分析兩組患者在年齡、術(shù)前疾病、合并癥、既往盆腔手術(shù)史、術(shù)前平均住院日、手術(shù)時(shí)間、術(shù)中出血量、術(shù)中并發(fā)癥、術(shù)后肛門排氣時(shí)間、術(shù)后恢復(fù)正常飲食時(shí)間、術(shù)后下床活動(dòng)時(shí)間、術(shù)后抗生素使用時(shí)間、術(shù)后止痛藥物使用率、術(shù)后病率、術(shù)后靜脈血栓形成、術(shù)后并發(fā)癥、術(shù)后平均住院時(shí)間及住院總花費(fèi)方面是否存在差異,以進(jìn)一步了解腹腔鏡手術(shù)在70歲以上老年女性患者中的安全性。結(jié)果(1)本資料共納入的170例患者手術(shù)均順利完成,腹腔鏡手術(shù)中無(wú)一例中轉(zhuǎn)開腹,成功率100%。(2)兩組患者術(shù)前一般情況比較:兩組患者在年齡、術(shù)前疾病分類、合并癥、既往盆腔手術(shù)史及術(shù)前平均住院日的比較上無(wú)顯著性統(tǒng)計(jì)學(xué)差異。(3)兩組患者術(shù)中情況比較:腹腔鏡組患者的平均手術(shù)時(shí)間(63.37±8.32)min明顯少于開腹組的平均手術(shù)時(shí)間(104.20±29.91)min(t=-12.957,P=0.000);腹腔鏡組術(shù)中出血量(36.78±13.93)ml明顯少于開腹手術(shù)組的出血量(130.31±83.19)ml(t=-10.505,P=0.000);腹腔鏡組患者術(shù)中未出現(xiàn)異常并發(fā)癥,開腹組中有1例患者術(shù)中出血約800ml,術(shù)中給予輸入懸浮紅細(xì)胞4u及冰凍血漿200ml以緩解手術(shù)危機(jī)。(4)兩組患者術(shù)后情況比較:腹腔鏡組患者的術(shù)后肛門排氣時(shí)間(1.48±0.97)d,明顯少于開腹組患者的術(shù)后肛門排氣時(shí)間(2.36±0.78)d(t=-6.472,P=0.000);術(shù)后恢復(fù)正常飲食時(shí)間(1.57±1.11)d,明顯少于開腹組患者的術(shù)后恢復(fù)正常飲食時(shí)間(2.79±1.56)d(t=-5.931,P=0.000);術(shù)后下床活動(dòng)時(shí)間(1.09±0.66)d,明顯少于開腹組患者的術(shù)后下床活動(dòng)時(shí)間(2.19±1.24)d(t=-6.60,P=0.000);術(shù)后抗生素使用時(shí)間(3.08±2.09)d,明顯少于開腹組患者的術(shù)后抗生素使用時(shí)間(4.55±2.14)d(t=-4.534,P=0.000);腹腔鏡組患者術(shù)后止痛藥使用率為16.7%,明顯少于開腹組患者的71.3%(χ2=2.778,P=0.096);腹腔鏡手術(shù)組發(fā)生下肢靜脈血栓2例(2.2%),明顯少于開腹手術(shù)組患者9例(11.3%)(χ2=5.704,P=0.017);術(shù)后平均住院時(shí)間(5.70±2.51)d,明顯少于開腹組患者的術(shù)后平均住院時(shí)間(8.65±3.22)d(t=-6.706,P=0.000);腹腔鏡手術(shù)組患者的術(shù)后病率為4.4%,開腹組患者的術(shù)后病率11.3%,無(wú)統(tǒng)計(jì)學(xué)差異(χ2=2.778,P=0.096);住院總花費(fèi)(24109.81±5350.06)元,明顯多于開腹組患者的住院總花費(fèi)(14066.75±6801.47)元(t=10.757,P=0.000);患者術(shù)后并發(fā)癥:腹腔鏡手術(shù)組1例患者發(fā)生腸梗阻,開腹手術(shù)組2例患者出現(xiàn)腹部切口愈合不良,3例患者發(fā)生腸梗阻。結(jié)論腹腔鏡在70歲以上老年婦科良性疾病中行全子宮雙側(cè)附件切除術(shù)中具有創(chuàng)傷小、疼痛輕、恢復(fù)快、并發(fā)癥少的優(yōu)點(diǎn),且安全性高,但費(fèi)用昂貴,有待改善。
[Abstract]:Background with the development of society, the proportion of the elderly is increasing year by year. Its age limit is defined as 65 years of age in epidemiology, but in clinical research, it is used as the lower limit for the screening of elderly patients at the age of 70, because it is reported that the function of the organs of the body is obviously reduced after 70 years of age, and it is generally considered to be the age limit of the body aging. With the increase of age, the function of various organs, tissues and systems of human body has gradually diminished, and the ability to stress external stress is gradually diminished, and the operation is also the same. With the application of laparoscopic technology, there is still a lot of controversy in the field of gynaecology. In the treatment of senile gynecologic benign diseases, the clinical comparative analysis was carried out to explore the safety of laparoscopy in the treatment of benign gynecologic diseases over 70 years old, and to provide a basis for the rational selection of surgical methods by clinicians. Methods the First Affiliated Hospital of Zhengzhou University was reviewed from January 1, 2005 to 201. The patients who were admitted to hospital in December 31st, 0 years, were diagnosed as benign gynecologic diseases with total uterine bilateral adnexectomy, excluding the patients with prolapse and vaginal prolapse. The total data of 170 cases were divided into two groups, 90 cases in the laparoscopy group and 80 in the open group. The SPSS21.0 soft ware system was used to analyze the age and Preoperation disease of two groups of patients. Complications, history of previous pelvic surgery, average length of hospital stay, operation time, intraoperative bleeding, intraoperative complications, postoperative anal exhaust time, postoperative recovery of normal diet time, postoperative ambulation time, postoperative antibiotic use, postoperative analgesic drug use, postoperative morbidity, postoperative venous thrombosis, postoperative complications and postoperative leveling. Whether there was a difference in the duration of hospitalization and the total cost of hospitalization in order to further understand the safety of the laparoscopic operation in the elderly women over 70 years old. Results (1) all the 170 cases of the patients were successfully completed. There were no cases of laparotomy in laparoscopy, and the success rate of 100%. (2) two groups before operation was compared. There was no significant statistical difference between the two groups in age, preoperative disease classification, complication, history of previous pelvic surgery and the average days of hospitalization. (3) in the two groups, the average operating time (63.37 + 8.32) min in the laparoscopic group was significantly less than the average operation time (104.20 + 29.91) min (t=-12.957, P=0) in the laparotomy group. .000); the amount of bleeding (36.78 + 13.93) ml in the laparoscopy group was significantly less than that of the laparotomy group (130.31 + 83.19) ml (t=-10.505, P=0.000); there were no abnormal complications in the laparoscopy group, and 1 of the patients in the laparotomy group had intraoperative hemorrhage of 800ml. (4) the operation crisis was relieved by the infusion of suspended erythrocyte 4U and frozen plasma 200ml. (4 Comparison of the two groups after operation: the postoperative anus exhaust time (1.48 + 0.97) d in the laparoscopic group was significantly less than that of the laparotomy group (2.36 + 0.78) d (t=-6.472, P=0.000), and the normal diet time (1.57 + 1.11) d after operation was significantly less than that of the laparotomy group (2.79 + 1.56) d (t=-5 .931, P=0.000) (1.09 + 0.66) after operation (1.09 + 0.66), obviously less than the operation time (2.19 + 1.24) d (t=-6.60, P=0.000) after operation in the laparotomy group (t=-6.60, P=0.000), and the postoperative antibiotic use time (3.08 + 2.09) d, obviously less than the postoperative antibiotic use time (4.55 + 2.14) d (t=-4.534, P=0.000) of the patients with the laparotomy group (t=-4.534, P=0.000), and the postoperative pain relief in the laparoscopic group. The drug use rate was 16.7%, obviously less than 71.3% (x 2=2.778, P=0.096) in the laparotomy group; 2 cases of lower limb venous thrombosis (2.2%) in the laparoscopic operation group were less than 9 (11.3%) (11.3%) (11.3%) (5.70 + 2.51) d after the operation, and the average hospitalization time (8.65 + 3.22) d (8.65 + 3.22) d after operation was significantly less than that of the laparotomy group. T=-6.706, P=0.000); the postoperative morbidity of the patients in the laparoscopic operation group was 4.4%, the postoperative morbidity of the open group was 11.3%, no statistical difference (x 2=2.778, P=0.096); the total cost of hospitalization was (24109.81 + 5350.06) yuan (14066.75 + 6801.47) yuan (14066.75 + 6801.47) yuan (t=10.757, P=0.000), and the postoperative complications: Laparoscopic hand In the operation group, 1 patients had intestinal obstruction, 2 patients in the open operation group had abdominal wound healing and 3 patients had intestinal obstruction. Conclusion laparoscopy has the advantages of small trauma, light pain, rapid recovery, and less hair symptoms in the elderly gynecologic benign diseases over the age of 70 years old, with high safety and high cost, but expensive. To be improved.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R713
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本文編號(hào)：2135520