CAJ | 학술논문

目的比较腹腔镜下传统子宫切除术与保留子宫动脉子宫切除术的临床疗效.方法因子宫良性病变需要行子宫切除术的112例患者按意愿分为保留子宫动脉上行支的腹腔镜下子宫切除术组(观察组,n =60)和传统腹腔镜下子宫切除术组(对照组,n=52),比较两组手术时间、术中出血量以及术后并发症发生率,比较两组术前、术后1个月、6个月、1年以及3年血清性激素以及血钙水平,比较观察组术前及术后血流动力学变化,比较两组围绝经期症状.结果观察组手术时间[(95.5 ±22.8) min]及术中出血量[(84.3±11.6)ml]明显多于对照组[(86.2±15.5) min、(68.8±7.2) ml](t=3.772、4.148,均P＜0.01).观察组术后排尿排便异常(1.7％)及术后发热发生率(1.7％)均明显低于对照组(11.5％、13.5％)(x2=4.623、5.843,均P＜0.05).观察组雌二醇水平在术后6个月开始下降,术后6个月、1年、3年与对照组差异均有统计学意义[(328.4±13.4) pmol/L与(304.8±15.2) pmol/L、(311.3±12.9) pmol/L与(248.5±13.6) pmol/L、(258.3±11.4) pmol/L与(138.7±12.7) pmol/L,t=8.758、25.121、52.688,均P＜0.05].两组卵泡刺激素(FSH)及黄体生成素(LH)水平术后1、3年差异均有统计学意义(t=-90.540、-123.229、-14.757、-19.845,均P＜0.01).两组血钙水平术后1年、3年差异均有统计学意义(t=3.261、3.050,均P＜0.05).观察组围绝经期症状较对照组少(x2=6.142、3.471、4.976、6.646、4.633,均P＜0.05).结论腹腔镜下保留子宫动脉上行支的子宫切除术是安全可靠的,治疗过程中较大限度地保存了子宫切除患者的卵巢功能,有利于提高妇女生活质量.
목적 비교복강경하전통자궁절제술여보류자궁동맥자궁절제술적림상료효.방법 인자궁량성병변수요행자궁절제술적112례환자안의원분위보류자궁동맥상행지적복강경하자궁절제술조(관찰조,n =60)화전통복강경하자궁절제술조(대조조,n=52),비교량조수술시간、술중출혈량이급술후병발증발생솔,비교량조술전、술후1개월、6개월、1년이급3년혈청성격소이급혈개수평,비교관찰조술전급술후혈류동역학변화,비교량조위절경기증상.결과 관찰조수술시간[(95.5 ±22.8) min]급술중출혈량[(84.3±11.6)ml]명현다우대조조[(86.2±15.5) min、(68.8±7.2) ml](t=3.772、4.148,균P＜0.01).관찰조술후배뇨배편이상(1.7％)급술후발열발생솔(1.7％)균명현저우대조조(11.5％、13.5％)(x2=4.623、5.843,균P＜0.05).관찰조자이순수평재술후6개월개시하강,술후6개월、1년、3년여대조조차이균유통계학의의[(328.4±13.4) pmol/L여(304.8±15.2) pmol/L、(311.3±12.9) pmol/L여(248.5±13.6) pmol/L、(258.3±11.4) pmol/L여(138.7±12.7) pmol/L,t=8.758、25.121、52.688,균P＜0.05].량조란포자격소(FSH)급황체생성소(LH)수평술후1、3년차이균유통계학의의(t=-90.540、-123.229、-14.757、-19.845,균P＜0.01).량조혈개수평술후1년、3년차이균유통계학의의(t=3.261、3.050,균P＜0.05).관찰조위절경기증상교대조조소(x2=6.142、3.471、4.976、6.646、4.633,균P＜0.05).결론 복강경하보류자궁동맥상행지적자궁절제술시안전가고적,치료과정중교대한도지보존료자궁절제환자적란소공능,유리우제고부녀생활질량.
Objective To compare the clinical effect of preserving the ascending uterine artery in laparoscopic hysterectomy with traditional laparoscopic hysterectomy.Methods 112 patients with various kinds of uterine benign lesions performed by hysterectomy were randomly divided into the preserving the ascending uterine artery in laparoscopic hysterectomy group(observation group,n =60) and traditional laparoscopic hysterectomy group (control group,n =52),The operation time,the intra operative blood loss,the postoperative complications rate and the perimenopausal symptoms in two groups were compared as well as the levels of blood calcium and the levels of hormone before operation,the first month,the sixth month,the first year,and the third year after operation.Results The opreration time [(95.5 ± 22.8) win] and intraoperative blood soss [(81.3 ± 11.6) ml] of the observation group was more than those of the control group [(68.8 ± 7.2) ml] (t =3.772,4.418,all P ＜ 0.05).The postoperative abnormal uniation and defection (1.7％) and fever incidence (1.7％) of the observation group was lower than those of the control group (11.5 ％,13.5 ％) (x2 =4.623,5.843,all P ＜ 0.05).The estradiol level of the observation group began to fall in 6 months postoperative,and had significant differences compare with those of the control group 6 months,1 year,3 years after operation [(328.4 ± 13.4) pmol/L vs (304.8 ± 15.2) pmol/L,(311.3 ± 12.9) pmol/L vs (248.5 ±13.6)pmol/L,(258.3 ± 11.4)pmol/L vs (138.7 ± 12.7)pmol/L] (t =8.758,25.121,52.688,all P ＜0.05).There was significant difference in the level of follicle stimulating hormone (FSH) and luteinizing hormone (LH) between the two groups 1,3 years after operation(t =-90.540,-123.229,-14.757,-19.845,all P ＜ 0.01).There was significant difference in the level of calcium between the two groups 1,3 years after operation(t =3.261,3.050,all P ＜0.05).The perimenopausal symptoms of the observation group was less than those of the control group(x2 =6.142,3.471,4.976,6.646,4.633,all P ＜ 0.05).Conclusion Laparoscopic hysterectomy of preserving the ascending uterine artery is safe and reliable;the recently ovarian function of the patients with hysterectomy is to maximize the preservation in the treatment,the women's quality of life will be to improved.