| Objective:A retrospective analysis of the operation of 80 cases of large uterus(uterine size 12?20 weeks of gestation)of the total hysterectomy were performed in Shenyang Women's And Children's Hospital from January 2016 to December 2018,and compared with transabdominal hysterectomy in the same period.At the same time,in order to determine the effect of the size of the uterus on the operation of the laparoscopic operation,80 cases of the laparoscopic hysterectomy group were selected as the laparoscopic group A(uterine size 12?<16 weeks of gestation)and the laparoscopic group B(uterine size 16?20 weeks of gestation),and comparing the intraoperative and postoperative conditions of the two subgroups,in order to explore the safety and feasibility of laparoscopic hysterectomy in large uterus,and to provide the basis for further widening the application of laparoscopic surgery in the field of gynecology.Methods:Cases of laparoscopic hysterectomy from January 2016 to December 2018 were screened according to certain inclusion criteria.A total of 80 cases of laparoscopic total hysterectomy with large uterus(uterine size 12?20 weeks of gestation)were collected as laparoscopic group,age(48.20±4.41)years old,and 50 cases of large uterus(uterine size 12 to 20 weeks of gestation)were treated with open abdominal group,age(47.96±4.28)years old.At the same time,the laparoscopy group were divided into two subgroups:laparoscopic group A(uterus size 12?<16 weeks of gestation)and laparoscopic group B(uterus size 16?20 weeks of gestation).The postoperative and postoperative complications were compared between the laparoscopic group and the open abdominal group and between the two sub-groups of the laparoscopic group,and the types and incidence of complications were also discussed.The SPSS23.0 statistical software was used for analysis.The measurement data were in accordance with the normal distribution,and the mean±standard deviation((?)±s)was used.The comparison between groups was performed by independent sample t test.Counting data use case(%)indicates that chi-square test is used for comparison between groups.If the expected frequency of any lattice is less than 1,or the total number of cases is less than 40.the exact probability test of Fisher is used.P<0.05 was considered statistically significant.Results:(?)Comparative study between laparoscopic and open abdominal hysterectomy:80 cases of laparoscopic group and 50 cases of open abdominal group were successfully completed.None of the laparoscopic groups were converted to open surgery.There was no significant difference in general data between laparoscopy group and open abdominal group(patient age,uterine size,body mass index,history of pelvic surgery,degree of pelvic adhesion,surgical indication,etc.),comparing the postoperative and postoperative conditions between the two groups.? The operation time:there was no significant difference between the operation time of the laparoscopic group(121.06±29.37)min and the operation time of the open abdominal group(131.00±31.46)min(P>0.05).?The blood loss during surgery:the blood loss(152.73 ±82.43)ml in the laparoscopic group and the blood loss(160.20 ± 82.84)ml in the open abdominal group were not statistically different(P>0.05).?Intraoperative complications:there were no secondary injuries in the two groups;one patient underwent intraoperative blood transfusion in the laparoscopic group and no intraoperative blood transfusion in the open abdominal group;? White blood cells,neutrophils and Hb:The first day after surgery,the white blood cell count(7.64±2.15)× 109/L,the neutrophil count(5.89 ± 2.00)× 109/L,Hb(100.9 ± 17.20)g/L in the laparoscopic group and white blood cell count(8.26±2.01)× 109/L,neutrophil count(6.46 ±2.08)× 109/L,Hb(104.18±22.10)g/L in the open abdominal group were not statistically different(P>0.05).The third day after surgery,the white blood cell count(6.52±1.76)× 109/L and the neutrophil count(4.62±1.23)×109/L in the laparoscopic group and the white blood cell count(7.01±1.96)×109/L,neutrophil count(5.04 ±1.56)× 109/L in the open abdominal group were not statistically different(P>0.05).?Postoperative anal exhaust time:The postoperative anal exhaust time of the laparoscopic group(23.09 ± 11.34)h was less than the postoperative anal exhaust time of the open abdominal group(30.61 ±12.40)h,the difference was statistically significant(P<0.05).?Postoperative hospital stay:The postoperative hospital stay(7.05±1.97)h in the laparoscopic group and postoperative hospital stay(7.32±0.98)h in the open abdominal group was not statistically different(P>0.05).?Postoperative complications:In the laparoscopic group,there were a case of vaginal stump bleeding and a case of vaginal stump polyps.In the open abdominal group,there were a case of incision fat liquefaction and a case of vaginal stump polyps.(?)Comparative study of laparoscopic hysterectomy in group A and B:?Operation time:the operation time(111.93±27.87)min in laparoscopic group A was less than the operation time(132.8±27.32)min in laparoscopic group B,the difference was statistically significant(P<0.05).?The blood loss during surgery:there was no significant difference between the blood loss(141.33±77.42)ml in laparoscopic group A between and the blood loss(174.57±89.03)ml in the laparoscopic group B(P>0.05).? Intraoperative complications:there were no cases of secondary in.jury in the two groups;one patient underwent intraoperative blood transfusion in the laparoscopic group B,and no intraoperative blood transfusion in the laparoscopic group A;?White blood cells,neutrophils count and Hb:The first day after surgery,the white blood cell count(7.46±2.11)× 109/L,neutrophil count(5.76±1.92)× 109/L,Hb(105.42±18.04)g/L in laparoscopic group A and the white blood cell count(7.87 ± 2.21)× 109/L,neutrophil count(6.06±2.11)×109/L.Hb(98.09±1 5.03)g/L in laparoscopic group B were not statistically different(P>0.05).The third day after surgery,the white blood cell count(6.31 ± 2.02)× 109/L,neutrophil count(5.1 ±1.32)× 109/L in the laparoscopic group A and the white blood cell count(7.02 ± 1.99)×109/L,neutrophil count(5.21±1.59)× 109/L in the laparoscopic group B were not statistically different(P>0.05).?Postoperative anal exhaust time:there was no significant difference between the postoperative anal exhaust time(22.79±11.64)h in the laparoscopic group A and the postoperative anal exhaust time(26.77±8.04)h in the laparoscopic group B(P>0.05).? Postoperative hospital stay:there was no significant difference between the postoperative hospital stay(7.40±2.45)h in the laparoscopic group A and the postoperative hospital stay(6.60±0.95)h in the laparoscopic group B(P>0.05).?Postoperative complications:There were no serious complications in the follow-up of the two groups of patients in this study.There were a case of vaginal stump polyps in the laparoscopic group A and a case of vaginal stump hemorrhage in the laparoscopic group B,and no other complications such as incision fat liquefaction and incisional hernia after laparoscopic surgery.Conclusions:1.The results showed that there was no significant difference in the operation time and blood loss between the laparoscopic group and the open abdominal group.The postoperative exhaust time in the laparoscopy group was shorter than that in the open abdominal group.2.Due to the limitation of the space of laparoscopic surgery,the difficulty of the laparoscopic total hysterectomy is increased with the increase of the volume of the uterus.The results of this study showed that with the increase of uterine volume,the time of laparoscopic hysterectomy was prolonged,and the amount of intraoperative blood loss was increased.However,all operations were successfully completed,no cases of conversion to open surgery,and the prognosis of patients after surgery is good.3.Laparoscopic total hysterectomy for large uterus is safe and feasible. |
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