【摘要】：目的:探討改良腹腔鏡下與開(kāi)腹切除子宮治療大子宮肌瘤在術(shù)中、術(shù)后相關(guān)指標(biāo)及術(shù)后生活質(zhì)量的分析比較。方法:將我院2015年1月到2017年1月符合納入手術(shù)標(biāo)準(zhǔn)的60例,為我院婦科同一主任醫(yī)師主刀的手術(shù)病例,按照手術(shù)方式分成觀察組A組(改良腹腔鏡下全子宮切除)33例、對(duì)照組B組(經(jīng)腹全子宮切除)27例兩組。比較兩組的一般情況、手術(shù)時(shí)間、術(shù)中出血量、術(shù)中術(shù)后并發(fā)癥率、術(shù)后肛門排氣時(shí)間、術(shù)后使用鎮(zhèn)痛藥率、術(shù)后住院時(shí)間、術(shù)后病率、術(shù)后標(biāo)本重量、手術(shù)費(fèi)用、腹部術(shù)口愈合情況及通過(guò)采用SF-36生活質(zhì)量問(wèn)卷調(diào)查量表評(píng)估兩組患者術(shù)后生活質(zhì)量情況。結(jié)果:順利完成33例改良腹腔鏡下全子宮切除和27例經(jīng)腹全子宮切除,兩組平均手術(shù)時(shí)間、圍手術(shù)期并發(fā)癥率、腹部術(shù)口甲級(jí)愈合率、術(shù)后病率、術(shù)后標(biāo)本重量差異沒(méi)有統(tǒng)計(jì)學(xué)意義(P0.05),兩組患者鎮(zhèn)痛藥使用率差異有統(tǒng)計(jì)學(xué)意義(P0.05);兩組手術(shù)術(shù)中平均出血量、術(shù)后住院時(shí)間、手術(shù)費(fèi)用、術(shù)后肛門排氣時(shí)間等差異均有統(tǒng)計(jì)學(xué)意義(P0.05);腹腔鏡組患者術(shù)后1個(gè)月SF-36生活質(zhì)量得分總分平均值顯著高于開(kāi)腹組患者術(shù)后1個(gè)月生活質(zhì)量(P0.05)。結(jié)論:1.改良腹腔鏡手術(shù)能更好暴露術(shù)野、有效的閉合大血管,作為一種婦科微創(chuàng)手術(shù),對(duì)于子宮增大到孕12-16周的大子宮切除在掌握其手術(shù)方法和技巧的前提下是安全、可行的。2.改良腹腔鏡下行大子宮切除術(shù)與開(kāi)腹手術(shù)相比有切口小、術(shù)中出血少、疼痛輕、恢復(fù)快、術(shù)后生活質(zhì)量好等優(yōu)勢(shì),是理想的值得推廣的手術(shù)方式。
[Abstract]:Objective: to investigate the relative indexes and quality of life (QOL) in the treatment of large uterine leiomyoma by modified laparoscopy and open hysterectomy. Methods: from January 2015 to January 2017, 60 patients who met the standard of operation were divided into group A (modified laparoscopic hysterectomy) and group A (33 cases). Control group B (total abdominal hysterectomy) 27 cases of two groups. The general condition, operation time, intraoperative bleeding volume, postoperative complications rate, postoperative anus exhaust time, postoperative analgesics use rate, postoperative hospitalization time, postoperative disease rate, postoperative specimen weight, operation cost were compared between the two groups. The healing of abdominal operation and the quality of life (QOL) were evaluated by SF-36 questionnaire. Results: 33 cases of modified laparoscopic hysterectomy and 27 cases of transabdominal hysterectomy were successfully completed. There was no significant difference in the weight of postoperative specimens (P0.05), and there was significant difference in the use of painkillers between the two groups (P0.05). There were significant differences in average blood loss, postoperative hospitalization time, operation cost and postoperative anal exhaust time between the two groups (P0.05). The total score of SF-36 quality of life in the laparoscopic group was significantly higher than that in the open group 1 month after operation (P0.05). Conclusion: 1. The modified laparoscopic surgery can better expose the surgical field and close the large blood vessels effectively. As a kind of gynecologic minimally invasive surgery, it is safe to remove the large uterus from uterine enlargement to 12-16 weeks gestation under the premise of mastering the operation methods and techniques. Feasible. 2. Compared with open surgery, modified laparoscopic hysterectomy has the advantages of less incision, less bleeding, less pain, quick recovery and good quality of life. It is an ideal operative method worth popularizing.
【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.33

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