Clinical efficacy of laparoscopic hysterectomy with suspension in elderly female patients

doi:10.3877/cma.j.issn.1673-5250.2020.06.016

Objective

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

Methods

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.

Results

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).

Conclusions

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.

Key words: Laparoscopes, Hysterectomy, Surgical procedures, minimally invasive, Postoperative complications, Comparative effectiveness research, Female

表1 2组接受子宫切除术患者的一般临床资料比较

组别	例数	年龄(岁，±s)	既往手术次数[次，M(P₂₅～P₇₅)]	上次手术和本次手术时间间隔(年，±s)
腹腔镜组	42	72.7±4.5	0.5(0～1.0)	6.7±1.8
开腹组	38	76.4±4.7	0.3(0～1.0)	5.0±1.9
检验值		t＝1.792	Z＝0.234	t＝1.712
P值		0.077	0.815	0.091

表1 2组接受子宫切除术患者的一般临床资料比较

组别	例数	年龄(岁，±s)	既往手术次数[次，M(P₂₅～P₇₅)]	上次手术和本次手术时间间隔(年，±s)
腹腔镜组	42	72.7±4.5	0.5(0～1.0)	6.7±1.8
开腹组	38	76.4±4.7	0.3(0～1.0)	5.0±1.9
检验值		t＝1.792	Z＝0.234	t＝1.712
P值		0.077	0.815	0.091

表2 2组接受子宫切除术患者术中及术后情况比较(±s)

组别	例数	手术持续时间(min)	术中出血量(mL)	术后疼痛评分(分)	切口长度(cm)	术后下床活动时间(h)	术后肛门排气时间(h)	住院时间(d)
腹腔镜组	42	45.3±7.4	8.8±1.7	3.1±1.1	2.8±0.6	13.9±3.9	17.3±4.2	7.8±1.4
开腹组	38	87.3±9.8`	76.6±13.2	6.7±1.5	10.3±1.9	51.5±8.6	42.0±4.2	13.1±2.9
t值		21.792	31.752	12.294	23.106	25.384	26.207	10.643
P值		<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

表2 2组接受子宫切除术患者术中及术后情况比较(±s)

组别	例数	手术持续时间(min)	术中出血量(mL)	术后疼痛评分(分)	切口长度(cm)	术后下床活动时间(h)	术后肛门排气时间(h)	住院时间(d)
腹腔镜组	42	45.3±7.4	8.8±1.7	3.1±1.1	2.8±0.6	13.9±3.9	17.3±4.2	7.8±1.4
开腹组	38	87.3±9.8`	76.6±13.2	6.7±1.5	10.3±1.9	51.5±8.6	42.0±4.2	13.1±2.9
t值		21.792	31.752	12.294	23.106	25.384	26.207	10.643
P值		<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

表3 2组子宫切除术患者术后并发症发生率比较[例数(%)]

组别	例数	切口感染	切口裂开	膀胱损伤	肠梗阻	下肢静脉血栓	肺部感染
腹腔镜组	42	1(2.4)	0(0)	0(0)	1(2.4)	1(2.4)	2(4.8)
开腹组	38	7(18.4)	5(13.2)	5(13.2)	2(5.3)	3(7.9)	5(13.2)
χ²值		4.060^a	3.863^a	3.863^a	0.008^a	0.292^a	0.867^a
P值		0.044	0.049	0.049	0.930	0.589	0.352

表3 2组子宫切除术患者术后并发症发生率比较[例数(%)]

组别	例数	切口感染	切口裂开	膀胱损伤	肠梗阻	下肢静脉血栓	肺部感染
腹腔镜组	42	1(2.4)	0(0)	0(0)	1(2.4)	1(2.4)	2(4.8)
开腹组	38	7(18.4)	5(13.2)	5(13.2)	2(5.3)	3(7.9)	5(13.2)
χ²值		4.060^a	3.863^a	3.863^a	0.008^a	0.292^a	0.867^a
P值		0.044	0.049	0.049	0.930	0.589	0.352

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