上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2017, Vol. 37 ›› Issue (12): 1664-.doi: 10.3969/j.issn.1674-8115.2017.12.015

• 论著（临床研究） • 上一篇    下一篇

腹腔镜手术在高龄老年女性妇科疾病诊治中的安全性研究

王岳萍，龙雯晴   

  1. 上海交通大学 医学院附属瑞金医院妇产科，上海  200025
  • 出版日期:2017-12-28 发布日期:2018-01-10
  • 通讯作者: 龙雯晴，电子信箱：lwq10500@rjh.com.cn
  • 作者简介:王岳萍 (1984—)，女，主治医师，硕士；电子信箱：wyp11670@rjh.com.cn

Safety of laparoscopic surgery in diagnosis and treatment of gynecologic diseases in elderly women#br#

WANG Yue-ping, LONG Wen-qing   

  1. Department of Obstetrics and Gynecology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Online:2017-12-28 Published:2018-01-10

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摘要： 目的 · 分析和探讨腹腔镜手术在 70 岁及以上老年患者妇科诊疗中应用的安全性。方法 · 回顾性分析 2009 年 1 月—2016 年 12 月在上海交通大学附属瑞金医院行妇科手术治疗的70 岁及以上老年患者420 例。按年龄分组，70 ～ 80 岁（包括70 岁）为高龄组， 80 岁及以上为超高龄组；按手术方式分为腹腔镜组和开腹组。记录患者年龄、美国麻醉师协会生理状况分级（ASA）、体质量指数 （BMI）、术前合并症、手术方式、手术情况、术后病理结果及并发症等，对结果进行统计分析。结果 · 同一年龄组腹腔镜手术和开腹 手术患者在年龄、ASA 分级、BMI 等方面差异均无统计学意义（均 P>0.05）；多数患者术前均合并多种慢性疾病。以全子宫切除术为 例，2 个年龄组的腹腔镜组在手术时间、出血量、排气时间及住院天数等方面均优于开腹组（均P<0.05）。 2 个年龄组的腹腔镜恶性 肿瘤根治 / 减灭手术均比开腹手术需要的手术时间短、术中出血少、排气时间快（均 P<0.05）。高龄腹腔镜组的术后切口愈合不良的 发生率较高龄开腹组低（P<0.05），但是其他术后并发症的发生率差异均无统计学意义（均 P>0.05）。全部患者均完成手术，无围手 术期死亡病例。结论 · 腹腔镜手术在高龄老年女性妇科良恶性疾病的诊治中安全性高，相比开腹手术时间短、术中出血少、术后恢复 快。

关键词: 腹腔镜, 老年女性, 高龄, 妇科疾病, 并发症

Abstract:

 Objective · To investigate safety of laparoscopic surgery in diagnosis and treatment of gynecologic diseases in elderly women over 70 years old.  Methods · A total of 420 cases of elderly patients over 70 years old from January 2009 to December 2016 were retrospectively analyzed in Shanghai Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. According to ages, the patients were divided into elderly group (70-80 years old, including 70 years old) and advanced age group (80 years old and above); according to surgical methods, the patients were divided into laparoscopy group and laparotomy group. The ages, American Society of Anesthesiology (ASA) classifications, body mass indexes (BMI), preoperative complications, surgical methods, intraoperative circumstances, postoperative pathology results and postoperative complications were analyzed.  Results · There were no significant differences in age, ASA classification and BMI between laparoscopy group and laparotomy group in the same age group (P<0.05). Most patients had various chronic diseases before operations. Taking total hysterectomy as an example, laparoscopy groups in the two age groups were superior to laparotomy groups in the comparison of surgical time, bleeding volume, anal evacuation time and length of hospital stay (P<0.05). In the two age groups, laparoscopic malignant tumor radical surgery took less time, less bleeding and shorter anal evacuation time than laparotomy (P<0.05). Elderly laparoscopy group had less poor wound healing cases than elderly laparotomy group (P<0.05), while there was no statistical difference in other postoperative complications (P>0.05). All the patients completed the surgeries without perioperative deaths.  Conclusion · Laparoscopy is safe in the diagnosis and treatment of gynecological benign and malignant diseases in elderly women with shorter operation time, less bleeding and faster postoperative recovery compared with laparotomy.

Key words:  laparoscopy, elderly woman, advanced age, gynecologic disease, complication