The Comparative Study Of Different Surgical Procedures Of Laparoscopic Total Hysterectomy

ObjectiveTo compare the situation of laparoscopic total hysterectomy and laparoscopic assisted vaginal hysterectomy before and after surgery by retrospective cohort study,to explore the two surgical indications,clinical efficacy,surgical difficulty,surgical risk,surgeon learning curve,etc.From the patients,surgeons and other external conditions and other aspects of comprehensive evaluation,for each case of patients with uterine disease to choose an ideal surgical approach,for clinical application to provide evidence.Methods:With the consent of the First Affiliated Hospital of Soochow University and Kunshan Municipal Hospital of traditional Chinese medicine hospital ethics committee,from November 2015 to December 2016,there were 66 cases with hysterectomy indications,they are through the case room information,outpatient medical records,admission records,surgical records,disease records,discharge records and other multi-channel comprehensive induction.Of the 66 cases,36 were LTH,30 were LAVH,and were grouped as follows:Laparoscopic total hysterectomy in 36 cases(LTH group):the age of patients(40~72)years,the average age of(56.11±2.10)years,uterine size of(14.54±1.21)gestational age,body mass index(23.31±2.78)kg/m~2;?Laparoscopic assisted vaginal hysterectomy in 30 cases(LAVH group):the age of patients(42~77)years,the average age of(57.12±3.01)years,uterine size of(12.56±1.37)gestational age,body mass index(22.12±2.91)kg/m~2.Comparison of two kinds of surgical instruments,surgical operation qualification,preoperative general condition,intraoperative bleeding volume,operation time,postoperative anal exhaust time,postoperative catheter time,postoperative hospitalization time,postoperative recovery time,postoperative decrease in hemoglobin,postoperative complications,hospitalization cost etc..To explore the indications,clinical efficacy,operative difficulty,surgical risk and learning curve of laparoscopic hysterectomy(LTH)and laparoscopic assisted vaginal hysterectomy(LAVH).The data were analyzed by SPSS 20.0 software.Measurement data to mean±standard deviation((?)±s),using t test;count data in terms of rate(%),using?~2 test.P<0.05indicates that the difference was statistically significant.ResultsLaparoscopic total hysterectomy in 36 cases(LTH group),laparoscopic assisted vaginal hysterectomy in 30 cases(LAVH group)surgery were successfully completed.There was no conversion to open surgery in two groups,no intraoperative and postoperative bleeding,no ureteral,bladder and intestinal injury occurred.1.The results showed that the general situation of patients:The average age of LTH group was(56.11±2.10)years old,body mass index was(23.31±2.78)kg/m~2,inclusion criteria for operation,and there was no significant difference between LTH group and LAVH group(P>0.05).LTH group uterine size(14.54±1.21)gestational age,compared with LAVH group was statistically significant(P<0.05).2.The results showed that the clinical efficacy of two surgical methods:LTH group operation time(118.23±16.77)min,intraoperative estimated blood loss(72.40±23.05)ml less than LAVH group,the difference was statistically significant(P<0.05);LTH group postoperative anal exhaust time(20.12±3.44)h,catheter time after operation(24.12±0.45)h,postoperative recovery time(25.01±0.74)h,postoperative hospitalization time(6.42±0.54)d,the amount of hemoglobin decreased after operation(5.01±0.93)g/l,compared with LAVH group,the difference was statistically significant(P<0.05).The incidence of postoperative complications in the LTH group was 2.78%,and the incidence of postoperative complications in the LAVH group was 6.67%,there was no statistically significant difference between the two groups(P>0.05).For the study of P value<0.05,although the difference was statistically significant,the two had achieved good surgical results.3.The results showed that the learning curve of two surgical patients:LTH group of surgical surgeon 36 people and LAVH group of surgical surgeon 30 people,chief physician,within 5 years of deputy chief physician,3 years deputy chief physician respectively were28,8,0and15,11,4;the difference was statistically significant(P<0.05).4.The study showed that the two surgical instruments and equipment:LTH group required Ligasure and unipolar coagulation hooks,LAVH group is not required.LTH group ultrasound knife usage rate of 100%,more than LAVH group of 60%.Indicating that the number of precision instruments and equipment required for operation in the LTH group was significantly more than that in the LAVH group,the difference was statistically significant(P<0.05).Conclusion1.LTH and LAVH two surgical methods are minimally invasive surgery,with a wide range of indications,trauma,less postoperative complications,quick recovery,etc.,are clinically effective and safe operation.2.LTH and LAVH had no significant difference in the choice of surgical methods,and can not be vaginal surgery and vaginal surgery difficult,obese,uterine volume>14 weeks of gestation and other patients with LTH surgery is more safe and feasible,LAVH is superior to uterine prolapse.3.The safe and effective operation of LTH and LAVH can not be separated from the precision equipment,Such as ultrasonic knife set the combination of coagulation and cutting,Ligasure(vascular closed system)to stop bleeding and tissue damage is small,These instruments and equipment to protect the safety of surgery to enhance the surgical time.4.LAVH is the basis for the gradual progress of laparoscopic surgery,In the initial stage of laparoscopic surgery,it is best to first LAVH,can be avoided to prevent organ damage caused by unskilled.5.LTH is one of the most operative techniques and the most difficult to learn in different laparoscopic hysterectomy.LTH is based on the further development of LAVH,LTH learning curve longer than LAVH,the general surgeon in 40 cases after surgery can reach a stable level of learning curve.The learning curve is closely related to the talent,the teachers and the simulated training of structuring tutorials.LTH may become the main stream of the hysterectomy in the future,the mastery and application of LTH lays the foundation for the development of laparoscopic total hysterectomy and pelvic lymphadenectomy.6.LTH and LAVH two kinds of surgery can not be completely replaced,should be based on the operation of laparoscopic surgery proficiency,patient condition and hospital equipment and other factors to consider the choice of surgery,the ultimate goal is to the best treatment to allow patients to achieve the best therapeutic effect.