腹腔镜在瘢痕子宫全子宫切除术中的应用

目的 分析腹腔镜在瘢痕子宫全子宫切除术中应用的可行性和安全性。方法 选择2018年3月~2019年3月在我院行腹腔镜全子宫切除术的患者98例，依据子宫是否瘢痕分为瘢痕组和非瘢痕组，各49例。比较两组手术时间、术中出血量、肛门排气时间、下床活动时间、并发症以及1次剖宫产与2次或以上剖宫产患者手术指标和并发症情况（术中出血量＞500 ml、膀胱穿孔、盆腔血肿、阴道残端出血）。结果 瘢痕组手术时间、术中出血量均高于非瘢痕组，差异有统计学意义（P＜0.05）；瘢痕组肛门排气时间、下床活动时间与非瘢痕组比较，差异无统计学意义（P＞0.05）；瘢痕组并发症发生率为12.24%，与非瘢痕组的16.33%比较，差异无统计学意义（P＞0.05）；1次剖宫产患者手术时间、术中出血量均低于2次或以上剖宫产患者，差异有统计学意义（P＜0.05）；1次剖宫产患者并发症发生率为17.86%，与2次或以上剖宫产患者的14.29%比较，差异无统计学意义（P＞0.05）。结论 腹腔镜应用于瘢痕子宫全子宫切除术中难度大于非瘢痕子宫，手术时间相对较长，术中出血量相对较多。但仍具有良好的安全可行性，且多次剖宫产患者在有经验的医生操作下，仍可经腹腔镜完成手术。

Laparoscopy in the Treatment of Scar Uterus Hysterectomy

Objective To analyze the feasibility and safety of laparoscopic application in total hysterectomy for scar uterus. Methods A total of 98 patients who underwent laparoscopic hysterectomy in our hospital from March 2018 to March 2019 were enrolled. According to whether the uterus was scar or not, the scar group and the non-scar group were divided into 49 cases. Comparison of operation time, intraoperative blood loss, anal exhaust time, time to get out of bed, complications, and 1 cesarean section and 2 or more cesarean section surgical indexes and complications (intraoperative blood loss > 500 ml, bladder perforation, pelvic hematoma, vaginal stump bleeding). Results The operation time and intraoperative blood loss of the scar group were higher than those of the non-scar group, the difference was statistically significant (P<0.05). There was no significant difference in the anus exhaust time and the time of getting out of bed in the scar group compared with the non-scar group(P>0.05); the incidence of complication in the scar group was 12.24%, compared with 16.32% in the non-scar group, the difference was not statistically significant (P>0.05);the operative time and intraoperative blood loss of patients with cesarean section were lower than 2 or more cesarean section patients, the difference was statistically significant (P<0.05); the complication rate of cesarean section was 17.85%,compared with 19.04% of patients with cesarean section 2 or more, the difference was not statistically significant (P>0.05). Conclusion Laparoscopy is more difficult than total non-scarred uterus in the treatment of scar hysterectomy. The operation time is relatively long and the amount of intraoperative blood loss is relatively high. However, it still has good safety and feasibility, and multiple cesarean section patients can still undergo laparoscopic surgery under the operation of experienced doctors.