CAJ | 학술논문

目的探讨既往盆腹腔手术对本次妇科腹腔镜手术的影响.方法回顾性分析北京大学第一医院2007年1月至2012年12月间因妇科疾病行腹腔镜手术的患者共3 283例,其中719例(21.90％)患者既往有盆腹腔手术史(研究组),2 564例(78.10％)患者无盆腹腔手术史(对照组).研究组719例患者中,既往手术次数:单次525例,多次194例;既往手术原因:妇科185例,产科305例,外科108例,混合(妇科、产科或外科原因中至少同时有两种者)121例;既往手术方式:开腹650例,腹腔镜69例.比较两组患者盆腔粘连情况及本次妇科腹腔镜手术情况(包括主套管针脐上穿刺比例、住院时间、手术时间、术中出血量、术中输血比例、中转开腹率以及手术并发症发生率),并分析研究组既往盆腹腔手术对盆腔粘连及本次腹腔镜手术的影响.结果研究组患者盆腹腔粘连的发生率为51.2％(368/719),明显高于对照组的8.2％(211/2 564,P＜0.01);但研究组粘连评分(中位数为3分)及粘连程度[轻度49.7％(183/368)、中度36.1％(133/368)、重度14.1％(52/368)]分别与对照组的粘连评分(中位数为2分)及粘连程度[轻度55.0％(116/211)、中度25.6％(54/211)、重度19.4％(41/211)]比较,差异均无统计学意义(P=0.930,P=0.684).研究组主套管针脐上穿刺比例为23.1％(166/719),明显高于对照组的3.3％ (85/2 564,P＜0.01);中转开腹率为0.6％(4/719),明显高于对照组的0.1％(2/2 564,P=0.023);而两组间住院时间、手术时间、术中出血量、术中输血比例及并发症发生率分别比较,差异均无统计学意义(P＞0.05).研究组患者中,既往因混合或妇科原因手术、多次手术史患者盆腹腔粘连的发生率、粘连程度均显著高于因产科或外科原因手术、单次手术史者(P＜0.01);既往多次手术患者与单次手术者相比,主套管针脐上穿刺比例、住院时间、手术时间、术中出血量均有统计学意义(P＜0.05),而术中输血比例、中转开腹率以及手术并发症发生率均无统计学意义(P＞0.05).结论既往有盆腹腔手术史的患者可以安全、成功地实施妇科腹腔镜手术,但是中转开腹率增加,对有多次手术史的患者因盆腔粘连加重而增加了手术难度. 目的探討既往盆腹腔手術對本次婦科腹腔鏡手術的影響.方法迴顧性分析北京大學第一醫院2007年1月至2012年12月間因婦科疾病行腹腔鏡手術的患者共3 283例,其中719例(21.90％)患者既往有盆腹腔手術史(研究組),2 564例(78.10％)患者無盆腹腔手術史(對照組).研究組719例患者中,既往手術次數:單次525例,多次194例;既往手術原因:婦科185例,產科305例,外科108例,混閤(婦科、產科或外科原因中至少同時有兩種者)121例;既往手術方式:開腹650例,腹腔鏡69例.比較兩組患者盆腔粘連情況及本次婦科腹腔鏡手術情況(包括主套管針臍上穿刺比例、住院時間、手術時間、術中齣血量、術中輸血比例、中轉開腹率以及手術併髮癥髮生率),併分析研究組既往盆腹腔手術對盆腔粘連及本次腹腔鏡手術的影響.結果研究組患者盆腹腔粘連的髮生率為51.2％(368/719),明顯高于對照組的8.2％(211/2 564,P＜0.01);但研究組粘連評分(中位數為3分)及粘連程度[輕度49.7％(183/368)、中度36.1％(133/368)、重度14.1％(52/368)]分彆與對照組的粘連評分(中位數為2分)及粘連程度[輕度55.0％(116/211)、中度25.6％(54/211)、重度19.4％(41/211)]比較,差異均無統計學意義(P=0.930,P=0.684).研究組主套管針臍上穿刺比例為23.1％(166/719),明顯高于對照組的3.3％ (85/2 564,P＜0.01);中轉開腹率為0.6％(4/719),明顯高于對照組的0.1％(2/2 564,P=0.023);而兩組間住院時間、手術時間、術中齣血量、術中輸血比例及併髮癥髮生率分彆比較,差異均無統計學意義(P＞0.05).研究組患者中,既往因混閤或婦科原因手術、多次手術史患者盆腹腔粘連的髮生率、粘連程度均顯著高于因產科或外科原因手術、單次手術史者(P＜0.01);既往多次手術患者與單次手術者相比,主套管針臍上穿刺比例、住院時間、手術時間、術中齣血量均有統計學意義(P＜0.05),而術中輸血比例、中轉開腹率以及手術併髮癥髮生率均無統計學意義(P＞0.05).結論既往有盆腹腔手術史的患者可以安全、成功地實施婦科腹腔鏡手術,但是中轉開腹率增加,對有多次手術史的患者因盆腔粘連加重而增加瞭手術難度.
목적 탐토기왕분복강수술대본차부과복강경수술적영향.방법 회고성분석북경대학제일의원2007년1월지2012년12월간인부과질병행복강경수술적환자공3 283례,기중719례(21.90％)환자기왕유분복강수술사(연구조),2 564례(78.10％)환자무분복강수술사(대조조).연구조719례환자중,기왕수술차수:단차525례,다차194례;기왕수술원인:부과185례,산과305례,외과108례,혼합(부과、산과혹외과원인중지소동시유량충자)121례;기왕수술방식:개복650례,복강경69례.비교량조환자분강점련정황급본차부과복강경수술정황(포괄주투관침제상천자비례、주원시간、수술시간、술중출혈량、술중수혈비례、중전개복솔이급수술병발증발생솔),병분석연구조기왕분복강수술대분강점련급본차복강경수술적영향.결과 연구조환자분복강점련적발생솔위51.2％(368/719),명현고우대조조적8.2％(211/2 564,P＜0.01);단연구조점련평분(중위수위3분)급점련정도[경도49.7％(183/368)、중도36.1％(133/368)、중도14.1％(52/368)]분별여대조조적점련평분(중위수위2분)급점련정도[경도55.0％(116/211)、중도25.6％(54/211)、중도19.4％(41/211)]비교,차이균무통계학의의(P=0.930,P=0.684).연구조주투관침제상천자비례위23.1％(166/719),명현고우대조조적3.3％ (85/2 564,P＜0.01);중전개복솔위0.6％(4/719),명현고우대조조적0.1％(2/2 564,P=0.023);이량조간주원시간、수술시간、술중출혈량、술중수혈비례급병발증발생솔분별비교,차이균무통계학의의(P＞0.05).연구조환자중,기왕인혼합혹부과원인수술、다차수술사환자분복강점련적발생솔、점련정도균현저고우인산과혹외과원인수술、단차수술사자(P＜0.01);기왕다차수술환자여단차수술자상비,주투관침제상천자비례、주원시간、수술시간、술중출혈량균유통계학의의(P＜0.05),이술중수혈비례、중전개복솔이급수술병발증발생솔균무통계학의의(P＞0.05).결론 기왕유분복강수술사적환자가이안전、성공지실시부과복강경수술,단시중전개복솔증가,대유다차수술사적환자인분강점련가중이증가료수술난도.
Objective To investigate the influence of previous abdominopelvic surgery on gynecological laparoscopic operation.Methods A retrospective analysis of 3 283 cases of gynecological diseases by laparoscopic operation patients in Peking University First Hospital from 2007 January to 2012 December,among them,719(21.90％) patients with previous abdominopelvic surgery history (study Group),2 564 (78.10％) patients have no history of abdominopelvic surgery (control group).Study group 719 patients,previous operation times:one time in 525 cases,194 cases were multiple; previous operation:185 cases of gynecological surgery,305 cases of obstetric surgery,108 cases of general surgery,and 121 complex surgery (include at least two kinds of surgery) ;previous operative approach:650 cases laparotomy and 69 cases laparoscopy.Compared two groups of patients with abdominopelvic adhesion and the gynecologic laparoscopic operation situation,analyzed the influence of previous abdominopelvic surgery on abdominopelvic adhesionon and gynecological laparoscopic operation.Results The incidence of abdominopelvic adhesion in the patients with previous abdominopelvic surgery was 51.2％ (368/719),which was significantly higher than that of 8.2％ (211/2 564) in patients without previous abdominopelvic surgery (P＜0.01).But the study group score (median 3) and the degree of abdominopelvic adhesion [mild 49.7％ (183/368),moderate 36.1％ (133/368),severe 14.1％ (52/368)] compared with the control group score (median 2) and degree [mild 55.0％(116/211),moderate 25.6％(54/211),and severe 19.4％(41/211)] were no statistical difference (P=0.930,P=0.684).Super-umbilical primary trocar site were chosen more common in patients with previous abdominopelvic surgery (23.1％,166/719) was significantly higher than that in the control group (3.3％,85/2 564; P＜0.01).And the rate of conversion to laparotomy was 0.6％ (4/719)significantly more than the control groups(0.l％,2/2 564; P=0.023).Compared with other groups,patients with gynecological or complex surgery or multiple operation history presented more severe abdominopelvic adhesion both in the score and degree (P＜0.01).The rate of super-umbilical primary trocar site,hospitalization time,operation time and bleeding during operation in patients with multiple operation history were significantly higher than those with single operation history (P＜0.05) ; the rate of blood transfusion,postoperative complication and conversion to laparotomy showed no statistical difference between the two groups (P＞0.05).Conclusion The laparoscopic operation could be carried out successfully and safely in patients with a history of various abdominopelvic operations,but the conversion rate increases,for patients with a history of multiple operation because of pelvic adhesion increases the difficulty of the laparoscopic operatio