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目的回顾性分析27例子宫次全切后行残留子宫颈切除术患者的临床资料,探讨子宫次全切后行残留子宫颈切除术的临床策略。方法回顾性分析我科2012-2014年收治的27例残留子宫颈切除患者的临床资料。患者均在院外行子宫次全切除术,并于我院接受残留子宫颈切除术。其中,开腹手术2例,腹腔镜中转开腹的1例,腹腔镜手术的24例。结果患者行次全子宫切除术时年龄为29~52(44.2±6.7)岁。2例因产后出血行子宫次全切除,25例因患者要求保留子宫颈行子宫次全切除。残留子宫颈切除时间距子宫次全切除术时间平均53(0.5~251.0)个月,包括宫颈残端肌瘤8例,宫颈残端癌19例。术后共发生4例并发症,包括肠瘘1例,肠梗阻1例,腹壁脓肿合并肺炎1例,膀胱阴道瘘1例。与同时期我院收治并行子宫全切的482例患者比较,残留子宫切除术患者手术时间更长,术中出血量更多,住院天数更久,住院费用更高,且差异有统计学意义(P<0.05,P<0.01)。结论行残留子宫颈切除应根据个人的手术习惯和对各种路入途径的掌握情况而定,但要由有经验的医师主刀。若患者坚决要求行次全子宫切除,术前应排除宫颈和内膜恶性病变,术后要求严密随访宫颈。
Objective To retrospectively analyze the clinical data of 27 cases of residual uterine cervix resection after subtotal hysterectomy and to discuss the clinical strategy of residual uterine cervix resection after subtotal hysterectomy. Methods Retrospective analysis of 27 cases of residual cervical resection in our department from 2012 to 2014 clinical data. Patients were in the hospital line subtotal hysterectomy, and in our hospital to accept residual cervical resection. Among them, laparotomy in 2 cases, laparoscopic conversion laparotomy in 1 case, laparoscopic surgery in 24 cases. Results The patients underwent subtotal hysterectomy was 29 to 52 (44.2 ± 6.7) years old. 2 cases of subtotal hysterectomy due to postpartum hemorrhage, 25 cases of patients required to retain the uterine cervix subtotal resection. Residual cervical excision time from subtotal hysterectomy time average 53 (0.5 ~ 251.0) months, including 8 cases of cervical stump fibroids, 19 cases of cervical stump cancer. Four complications occurred after operation, including 1 case of intestinal fistula, 1 case of intestinal obstruction, 1 case of abdominal abscess with pneumonia and 1 case of vesicovaginal fistula. Compared with 482 patients undergoing simultaneous hysterectomy in our hospital during the same period, residual hysterectomy patients had longer operation time, more intraoperative blood loss, longer hospitalization days, higher hospitalization costs, and the difference was statistically significant ( P <0.05, P <0.01). Conclusion Residual cervical excision should be based on individual surgical habits and access to various ways to grasp the situation may be, but by the experienced surgeon. If the patient resolutely asked for the line of hysterectomy, preoperative cervical and endometrial malignant lesions should be excluded after strict follow-up of the cervix.