探讨对老年女性患者采用腹腔镜下悬吊式子宫切除术的临床疗效。

选择2014年1月至2017年4月，武汉市第一医院妇科收治的因子宫内膜重度不典型增生、宫颈上皮内瘤变(CIN)3、子宫内膜样腺癌、子宫肌瘤等行子宫切除术的80例老年女性患者(年龄≥60岁)为研究对象。采用随机数字表法，将其分别纳入腹腔镜组(n＝42，采用腹腔镜下悬吊式子宫切除术)和开腹组(n＝38，采用开腹子宫切除术)。采用t检验，对2组患者年龄、手术持续时间、术中出血量、术后疼痛评分、切口长度、住院时间，以及术后下床活动时间、肛门排气时间进行统计学分析。采用χ²检验，对2组患者切口感染、切口裂开、膀胱损伤、肠梗阻、下肢静脉血栓和肺部感染等并发症发生率进行统计学分析。本研究遵循的程序符合2013年新修订的《世界医学协会赫尔辛基宣言》要求，并与所有受试者均签署临床研究知情同意书。

①2组患者年龄、既往手术次数、上次手术和本次手术时间间隔等一般临床资料分别比较，差异均无统计学意义(P>0.05)。②腹腔镜组患者手术持续时间、住院时间及术后下床活动时间与肛门排气时间均短于开腹组，并且腹腔镜组患者术中出血量、术后疼痛评分及切口长度均低于或短于开腹组，2组比较，差异均有统计学意义(P<0.05)。③腹腔镜组患者的切口感染、切口裂开和膀胱损伤发生率分别为2.4%(1/42)、0和0，显著低于开腹组的18.4%(7/38)、13.2%(5/38)和13.2%(5/38)，2组比较，差异均有统计学意义(χ²＝4.060、3.863、3.863，P＝0.044、0.049、0.049)。2组患者的肠梗阻、下肢静脉血栓和肺部感染等并发症发生率比较，差异均无统计学意义(P>0.05)。

对老年女性患者采用腹腔镜下悬吊式子宫切除术的疗效显著、安全。因本研究仅为回顾性研究，该技术在临床推广应用价值，还需要大样本、多中心、随机对照试验进一步研究、证实。

To investigate clinical efficacy of laparoscopic hysterectomy with suspension type in elderly female patients.

From January 2014 to April 2017, a total of 80 elderly female patients with severe endometrial dysplasia, cervical intraepithelial neoplasia (CIN) 3, endometrioid adenocarcinoma, and uterine fibroids who underwent hysterectomy in the Department of Gynecology, Wuhan No. 1 Hospital were selected into this study. By random number table method, they were divided into laparoscope group (n=42, laparoscopic hysterectomy with suspension type) and laparotomy group (n=38, open hysterectomy). The age, operation duration, intraoperative blood loss, postoperative pain score, incision length, early ambulation after operation, postoperative anus exhaust time and hospital stay were statistically compared between two groups by independent-samples t test. The incidence rate of complications such as incision infection, incision dehiscence, bladder injury, intestinal obstruction, lower limb venous thrombosis and pulmonary infection between two groups were statistically analyze by chi-square test. The procedures followed in this study were in line with the requirements of World Medical Association Declaration of Helsinki revised in 2013. Informed consent was obtained from all patients.

①There were no significant differences in general clinical data, such as age, number of previous operations, time interval between last operation and this operation between two groups (P>0.05). ②The operation duration, ambulation after operation, postoperative anal exhaust time and hospitalization time of patients in laparoscopic group were shorter than those in laparotomy group, and the intraoperative blood loss volume, postoperative pain score and incision length of patients in laparoscopic group were less than those in laparotomy group, and the differences between two groups were statistically significant (P<0.05). ③The incidence of incision infection, incision dehiscence and bladder injury in laparoscopic group were 2.4% (1/42), 0 and 0, respectively, which were significantly lower than those in laparotomy group 18.4% (7/38), 13.2% (5/38) and 13.2% (5/38), there were statistically significant differences (χ²=4.060, 3.863, 3.863; P=0.044, 0.049, 0.049). There was no statistical significance in the incidence of complications such as intestinal obstruction, lower limb venous thrombosis and pulmonary infection between two groups (P>0.05).

Elderly female patients undergoing laparoscopic hysterectomy with suspension type had significant efficacy. As the sample size of this study is relatively small, whether this operation method is worthy of clinical application or not, it still needs to be confirmed by large-sample, multi-center and randomized controlled studies.