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目的探讨腹腔镜辅助阴式子宫切除术(LAVH)患者的手术并发症以及恶性肿瘤的发生情况。方法对253例行LAVH患者的临床资料进行回顾性分析,并选取同期开腹子宫切除手术150例进行对比。结果253例患者平均子宫三径线之和为(24.4±8.3)cm,249例(98.42%)患者通过腹腔镜成功完成手术,4例(1.58%)中转开腹。手术时间为(134±32)min,术中出血(465±326)ml,术后血红蛋白含量较术前减少(10.2±7.1)g/L。36例(14.23%)术中出血>400ml,1例(0.39%)皮下血肿,6例(2.37%)泌尿系统损伤,1例(0.39%)肠道损伤,1例(0.39%)腓总神经麻痹。无伤口愈合不良、延期愈合患者。1例(0.39%)术后发现子宫内膜癌。结论LAVH可以造成出血及脏器损伤等合并症,其发生与盆腔严重粘连、肌瘤体积大、病例的选择以及术中处理有关。术前未发现恶性的概率为0.39%。
Objective To investigate the surgical complications of laparoscopic assisted vaginal hysterectomy (LAVH) and the incidence of malignant tumors. Methods The clinical data of 253 patients with LAVH were retrospectively analyzed and compared with 150 cases of open hysterectomy during the same period. Results The mean uterine diameter of the 253 patients was (24.4 ± 8.3) cm. A total of 249 patients (98.42%) underwent laparoscopic surgery and 4 patients (1.58%) underwent laparotomy. The operative time was (134 ± 32) min and the intraoperative bleeding was (465 ± 326) ml. The postoperative hemoglobin content was decreased by (10.2 ± 7.1) g / L. 36 cases (14.23%) had intraoperative bleeding> 400ml, 1 case (0.39%) subcutaneous hematoma, 6 cases (2.37%) urinary system injury, 1 case (0.39%) intestinal injury and 1 case paralysis. No wound healing, delayed healing patients. One patient (0.39%) found endometrial cancer after operation. Conclusion LAVH can cause complications such as hemorrhage and organ injury. The occurrence of LAVH is associated with severe pelvic adhesions, large volume of myoma, choice of cases and intraoperative management. The probability of preoperative non-malignant was 0.39%.