Clinical Analysis About Poor Healing Of Vaginal Stump After Laparoscopic Hysterectomy

[Objective]1.To explore the risk factors in the poor healing of wounded vaginal stumps after laparoscopic panhysterectomy during perioperative period,and explore the effect of different treatment regimens on the length of hospital stays.2.Analyze the risk factors and treatment regimens,to provide suggestions for clinical practice.[Methods]Collect the total number of 25 patients,who were rehospitalized due to poor healing of wounded vaginal stumps at the time of return visit after Guangdong Maternal and Child Health Hospital from May 2014 to November 2021 were laparoscopic panhysterectomy as the case groups.Chose the patient of 112 cases randomly,who was conducted the surgery of the same type,as the control group.The condition enrolled in the case group is that patients were existing active bleeding,dehiscence and infection in the vaginal stumps by the confirmation of the gynecologists,or neoplasm cut from surgical removal of vaginal stumps,were confirmed as inflammatory granulomatous tissues in pathological diagnosis during return visits.The condition enrolled in the control group is that patients went to see the doctor again due to the clinical manifestations of poor wound healing of the vaginal stumps during the half a year of regular follow-up visiting after operations.Collected the different perioperative factors including ages,preoperative cervical cone resection rates,curettage ratios,serum albumin values,uterine sizes,operative time,hemorrhagic volume,intestinal adhesions and/or pelvic adhesions,proportions of patients with ovarian preservation,postoperative venous hemoglobin and postoperative anemia,conducted single factor analysis,introduced bivariate logsitic regression analysis to the differences with the statistic meaning,and drew a conclusion of independent risk factors in appearance of poor healing of wounded vaginal stumps.In order to evaluate the relevance of the drug of human albumin in promoting the healing of vaginal stumps,patients with poor healing of wounded vaginal stumps were randomly divided into groups.Among them,the patients who were treated with human albumin solution were included into the treatment group and patients who did not use human albumin were included into the observation group.The difference analysis was performed,to evaluate the efficacy of human albumin on poor healing of wounded vaginal stumps,which provide reference for clinical practice.[Result]1.The age of the case group was significantly lower than that of the control group,and the operation time in the case group was significantly longer than that of the control group.These differences was of statistic meaning(P<0.05).The differences between the groups in the proportions of patients undergoing cervical cone resection,the proportions of patients undergoing staged curettage,serum albumin levels,uterine sizes,hemorrhagic volume,intestinal adhesions and/or pelvic adhesions during operation,the proportions of patients with ovarian preservation,postoperative hemoglobin and anemia were not of statistic meaning(P>0.05).The difference analysis was conducted between the case group and the observation group depending on whether adopted the treatment by intravenous drip of human albumin,and the results showed that the level of basal serum albumin before hysterectomy was higher than that of observation group.This difference was of statistic meaning(P<0.05).But the differences between the case group and the observation group in ages,malignant tumor proportions,postoperative hemoglobin values and hospitalization time for the poor healing of wounded vaginal stumps were not of statistic meaning(P>0.05).2.Calculating the independent risk factors showed the operation time(OR=1.013,95%CI=1.001,1.025,P<0.05)was prolonged and the risk in poor healing of wounded vaginal stumps was increased.With the age(OR=0.855,95%CI=0.780,0.937,P<0.00)was increased and the risk in poor healing of wounded vaginal stumps was reduced.[Conclusion]1.With increased operative time,the risks would be higher in poor healing of wounded vaginal stumps of young patients.2.There were not significant association with the outcome with poor healing of wounded vaginal stumps in whether performing cervical cone resection before hysterectomy,whether performing staged curettage,serum albumin level,uterine size,hemorrhagic volume,presence or absence of intestinal adhesions and/or pelvic adhesions during operation,ovarian preservation,postoperative hemoglobin value,and anemia.3.During the clinical working,various measures should be taken to shorten the operation time.The young patients should be fully educated before operation,and recommended to have reasonable rest after surgery.Avoiding physical work too early may be beneficial to the healing of wounded vaginal stumps.4.Weigh the advantages and disadvantages of using human albumin,while treating patients with poor healing of wounded vaginal stumps.