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中华妇幼临床医学杂志(电子版) ›› 2009, Vol. 05 ›› Issue (02) : 127 -131. doi: 10.3877/cma.j.issn.1673-5250.2009.02.107

论著

腹腔镜手术在老年妇科良性疾病中的应用
祝茜, 张立, 陈洪琴, 阮佳英, 石钢   
  1. 610041 成都,四川大学华西第二医院妇产科
  • 出版日期:2009-04-01

Application of Laparoscopy in Benign Gynecological Diseases for Elderly Women.

Qian ZHU, Li ZHANG, Hong-qin CHEN, Gang SHI   

  1. West China Second University Hospital, Sichuan University, Chengdu 610041, China
  • Published:2009-04-01
引用本文:

祝茜, 张立, 陈洪琴, 阮佳英, 石钢. 腹腔镜手术在老年妇科良性疾病中的应用[J/OL]. 中华妇幼临床医学杂志(电子版), 2009, 05(02): 127-131.

Qian ZHU, Li ZHANG, Hong-qin CHEN, Gang SHI. Application of Laparoscopy in Benign Gynecological Diseases for Elderly Women.[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2009, 05(02): 127-131.

目的

研究腹腔镜手术在老年妇科良性疾病患者中的临床应用,探讨腹腔镜的老年妇女患者适应证。

方法

回顾性分析2004年8月至2007年10月,因妇科良性疾病在四川大学华西第二医院行手术治疗的189例患者(恶性肿瘤手术及阴式手术患者除外),年龄>60岁。根据手术类别,将其分为腹腔镜组(n=53)和经腹手术组(n=136)(分组遵循程序符合本院负责人体试验委员会所制定的伦理学标准,并得到该委员会批准,且分组征得患者本人的知情同意)。

结果

腹腔镜组处理附件包块(附件切除腹腔镜亚组,n=42)时,术中血压波动较附件切除经腹手术亚组(n=43)小,术后口服非甾体类药物镇痛,且抗生素用量少;而经腹手术组患者需应用阿片类药物镇痛。附件切除术腹腔镜亚组患者术后进食、停尿管、肛门排气时间早于附件切除术经腹手术组,且术后住院时间短。其余手术类型两组比较,差异无显著意义(P>0.05)。腹腔镜组患者术后并发症发生率为5.66%(3/53),经腹手术组为16.91%(23/136),两组比较,差异有显著意义(P<0.05)。

结论

附件切除术腹腔镜手术较开腹术对老年妇科良性疾病患者的手术打击,心、肺,内环境影响更小,术后恢复更快。故对老年患者持续存在的附件包块,应积极行腹腔镜探查术。

Objective

To assess the clinical application of laparoscopic surgery in the management of benign gynecological diseases for elderly women.

Methods

From August 2004 to October 2007, 189 women aged more than 60-year-old who underwent laparoscopy or open surgery for suspected benign gynecological diseases were reviewed retrospectively(except for the malignant tumor operation and transvaginal surgery). They were divided into laparoscopy group (n=53) and open surgery group (n=136), sub-laparoscopy group (n=42, adnexectomy) and sub-open surgery group (n=43, adnexectomy). Informed consent was obtained from all patients.

Results

Sub-laparoscopy group showed lower perioperative blood pressure fluctuation than sub-open surgery group in the management of adnexectomy. Non-steroidal drugs were used for postoperative analgesia after laparoscopy while opioid drugs were used for patients who underwent laparotomy. Compared with sub-open surgery group, the usage of antibiotics, time to have semifluid, time of putting urethral catheter away, time of intestinal ventilation and days of hospitalization were significantly lower in sub-laparoscopic group. But there were no statistical significance of other types of surgery between two groups. The postoperative complications of laparoscopy group and open surgery group were 5.66%(3/53) and 16.91%(23/136), respectively.

Conclusion

Laparoscopic adnexectomy has a milder injury and smaller impact on cardiorespiratory function and internal environment for elderly patients than those of laparotomy. Elderly women with persistent adnexal masses should take laparoscopy more actively.

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