CAJ | 학술논문

目的：探讨单孔腹腔镜辅助下阴式子宫全切除术及阴式子宫全切术在临床应用中的安全及有效性。方法选择2013年1月~2014年9月成都市第五人民医院妇科收治拟行子宫全切患者70例为研究对象，采用随机数字表法将其分为单孔腹腔镜辅助阴式组和阴式组，每组各35例。单孔腹腔镜辅助阴式组患者采用经脐单孔腹腔镜辅助下阴式全子宫切除术，阴式组采用阴式全子宫切除术。分析比较两组患者年龄、体重指数、阴道分娩史、盆腔手术史及本次切除子宫原因、手术时间、出血量、子宫重量、术后即刻视觉模拟评分(VAS)、术后1、3、7 d VAS、术后排气时间、术后住院时间、住院费用、并发症情况及中转手术情况。结果阴式组术后即刻VAS评分、手术时间、术后排气时间及住院费用优于单孔腹腔镜辅助阴式组，差异均有高度统计学意义(P<0.01)。阴式组术中并发症及中转开腹发生率明显高于单孔腹腔镜辅助阴式组，差异有统计学意义(P<0.05)。单孔腹腔镜辅助阴式组术后并发症总发生率为8.57%，明显低于对照组的25.71%，差异有统计学意义(P<0.05)。单孔腹腔镜辅助阴式组患者术后1、3、7 d VAS评分均显著低于阴式组，差异均有统计学意义(P<0.05)。结论阴式子宫全切手术为经自然腔道手术，具有更微创的优点，但因安全的原因，单孔腹腔镜辅助阴式子宫切除手术更值得推广。
목적：탐토단공복강경보조하음식자궁전절제술급음식자궁전절술재림상응용중적안전급유효성。방법선택2013년1월~2014년9월성도시제오인민의원부과수치의행자궁전절환자70례위연구대상，채용수궤수자표법장기분위단공복강경보조음식조화음식조，매조각35례。단공복강경보조음식조환자채용경제단공복강경보조하음식전자궁절제술，음식조채용음식전자궁절제술。분석비교량조환자년령、체중지수、음도분면사、분강수술사급본차절제자궁원인、수술시간、출혈량、자궁중량、술후즉각시각모의평분(VAS)、술후1、3、7 d VAS、술후배기시간、술후주원시간、주원비용、병발증정황급중전수술정황。결과음식조술후즉각VAS평분、수술시간、술후배기시간급주원비용우우단공복강경보조음식조，차이균유고도통계학의의(P<0.01)。음식조술중병발증급중전개복발생솔명현고우단공복강경보조음식조，차이유통계학의의(P<0.05)。단공복강경보조음식조술후병발증총발생솔위8.57%，명현저우대조조적25.71%，차이유통계학의의(P<0.05)。단공복강경보조음식조환자술후1、3、7 d VAS평분균현저저우음식조，차이균유통계학의의(P<0.05)。결론음식자궁전절수술위경자연강도수술，구유경미창적우점，단인안전적원인，단공복강경보조음식자궁절제수술경치득추엄。
Objective To explore the safety and effectiveness of clinical application between single-incision laparo-scopic assisted vaginal hysterectomy and vaginal hysterectomy. Methods 70 cases of hysterectomy from January 2013 to September 2014 in the Fifth People’s Hospital of Chengdu City were selected as study objects, who were divided in-to single-incision laparoscopic assisted vaginal hysterectomy group and vaginal hysterectomy group according to the random number table, with 35 cases in each group. Patients of the single-incision laparoscopic assisted vaginal hys-terectomy group were given single-incision laparoscopic assisted vaginal hysterectomy, and vaginal hysterectomy group were given vaginal hysterectomy. The BMI, history of vaginal delivery, pelvic operation history, causes of hysterectomy, operation time, bleeding volume, weight of the uterus, VAS of immediate postoperative, VAS of 1, 3, 7 d postoperative, postoperative exhaust time, postoperative hospitalization time, hospitalization expenses, complications and conversion operation were analyzed and compared between two groups. Results The postoperative pain, operation time, postopera-tive exhaust time and hospitalization expenses of the vaginal hysterectomy group was better than those of the single hole laparoscopic assisted vaginal hysterectomy group, the differences were statistically significant (P<0.01). Rate of intra-operative complications and conversion to laparotomy of the vaginal hysterectomy group was lower than that of the sin-gle hole laparoscopic assisted vaginal hysterectomy group, the difference was statistically significant (P<0.05). Complica-tion total rate of the single hole laparoscopic assisted vaginal hysterectomy group was 8.57%, significantly lower than that of the vaginal hysterectomy group 25.71%, the difference was statistically significant (P<0.05). VAS at 1, 3, 7 d post-operative in single hole laparoscopic assisted vaginal hysterectomy group were significantly lower than those of the vaginal group, the difference was statistically significant (P<0.05). Conclusion Vaginal hysterectomy as a natural ori-fice transluminal endoscopic surgery is minimally invasive, but for security reasons, single-incision laparoscopic assist-ed vaginal hysterectomy operation more worthy of promotion.