2018 年第 8 期 第 13 卷

妇科良性疾病腹腔镜术中和术后出血相关因素分析

Influence factors of intraoperative and postoperative hemorrhage in gynecological laparoscopic surgery treating benign disease

作者：欧阳卓陈敏秀田星月王文文翟建军

英文作者：

单位：100730首都医科大学附属北京同仁医院妇产科

英文单位：

关键词：妇科腹腔镜；手术出血

英文关键词：

• 摘要：

• 【摘要】目的    探讨妇科良性疾病腹腔镜术中和术后出血的相关因素。方法    回顾性选取2009年10月至2017年10月首都医科大学附属北京同仁医院妇产科行妇科腹腔镜手术患者3 171例，均经术后病理证实为妇科良性疾病。分析术中和术后出血与手术方式、盆腹腔粘连、手术医师的临床经验和术毕检查的相关性。结果    本研究3 171例患者术中和术后出血104例，发生率为3.3%。非附件手术和子宫内膜异位病灶切除术的术中和术后出血发生率明显高于附件手术［5.0%（53/1 057）、3.9%（41/1 057）比0.9%（10/1 057）］，合并盆腹腔粘连的卵巢子宫内膜异位囊肿剔除术的术中和术后出血发生率明显高于不合并盆腹腔粘连的其他病理类型的卵巢囊肿手术［4.0%(14/350)比0.6%(2/350)］，从事腹腔镜手术5年临床经验以下的医师操作引起术中和术后出血发生率明显高于有10年临床经验以上医师 ［4.5%(95/2 114)比0.9%(9/1 057)］，术毕行全面规范检查手术的术中和术后出血发生率明显低于术毕未行全面规范检查手术［0.3%(9/2 815)比26.7%（95/356）］，差异均有统计学意义（均P＜0.05）。结论    手术方式、盆腹腔粘连、手术医师临床经验和术毕全面规范的检查与妇科良性疾病腹腔镜术中和术后出血密切相关。

• Objective    To investigate the influence factors of intraoperative and postoperative hemorrhage in laparoscopic surgery treating gynecological benign disease. Methods    Clinical records of 3 171 patients who had gynecological laparoscopic surgery in Beijing Tongren Hospital, Capital Medical University from October 2009 to October 2017 were retrospectively analyzed. All cases were diagnosed of gynecological benign disease by postoperative pathological Results    . Relations of intraoperative and postoperative hemorrhage with different surgical procedures, comorbidity of pelvic-abdominal adhesion, experience of doctor and postoperative examination were analyzed. Results    Incidence of hemorrhage in 3 171 patients was 3.3%（n＝104）. Incidence of hemorrhage in non-adnexa surgery and endometriosis resection was significantly higher than that in uterine adnexa surgery［5.0%（53/1 057）, 3.9%（41/1 057） vs 0.9%（10/1 057）］(P＜0.05). Incidence of hemorrhage in resection of ovarian endometriosis cyst with pelvic-abdominal adhesion was significantly higher than that in resection of ovarian cyst without pelvic-abdominal adhesion［4.0%(14/350) vs 0.6%(2/350)］(P＜0.05). Incidence of hemorrhage in laparoscopic surgery operated by doctor with less than 5-year experience was significantly higher than that in surgery operated by doctor with more than 10-year of experience［4.5%(95/2 114) vs 0.9%(9/1 057)］(P＜0.05). Incidence of hemorrhage in patient with comprehensive and standard postoperative examination was significantly higher than that in patient without postoperative examination［0.3%(9/2 815) vs 26.7%(95/356)］(P＜0.05). Conclusion    Surgical procedure of gynecological laparoscopic surgery, comorbidity of pelvic-abdominal adhesion, experience of doctor and standard postoperative examination are associated with the occurrence of intraoperative and postoperative hemorrhage.