摘要
目的探讨腹腔镜全子宫切除术中应用不同能量器械对手术疗效及盆底功能的影响。方法选取2022年1月至2024年12月接受腹腔镜全子宫切除术的240例患者,按术中能量器械分为超声刀组、双极电凝组和单极电凝组,每组80例。比较三组围手术期指标及术后盆底功能结果。结果超声刀组手术时间、术中出血量及术后住院时间均优于双极电凝组和单极电凝组(P<0.001)。术后6个月,盆底功能障碍问卷(pelvic floor distress inventory-short form 20,PFDI-20)评分、盆底障碍影响量化表(pelvic floor impact questionnaire,PFIQ-7)评分、盆底肌力、尿动力学及盆底超声指标三组比较均有统计学差异(P<0.001),其中超声刀组显著优于其他两组,双极电凝组优于单极电凝组(P<0.001)。三组并发症发生率比较无统计学差异(P>0.05)。结论对于腹腔镜全子宫切除术,操作中须注意保护盆底功能。选用超声刀可最大限度地减少术后盆底损伤,双极电凝次之,单极电凝影响最为显著。因此,在行腹腔镜全子宫切除术时建议优先选用超声刀。
Objective To explore the effects of different energy devices on pelvic floor functions in laparoscopic total hysterectomy.Methods 240 patients who underwent laparoscopic total hysterectomy from January 2022 to December 2024 were selected and divided into three groups according to the energy devices used during the operation:the harmonic scalpel group,the bipolar electrocoagulation group,and the monopolar electrocoagulation group,with 80 cases in each group.The perioperative indicators and postoperative pelvic floor function assessment results of the three groups were compared.Results The operation time,intraoperative blood loss,and postoperative hospital stay in the harmonic scalpel group were all better than those in the bipolar electrocoagulation group and the monopolar electrocoagulation group(P<0.001).At 6 months postoperatively,pelvic floor distress inventory-short form 20(PFDI-20),pelvic floor impact questionnaire(PFIQ-7),pelvic floor muscle strength grading,and urodynamic indicators in the harmonic scalpel group were significantly better than those in the other two groups,and the bipolar electrocoagulation group was better than the monopolar electrocoagulation group(P<0.001).There was no statistically significant difference in the incidence of com-plications among the three groups(P>0.05).Conclusions For patients undergoing laparoscopic total hyster-ectomy,doctors should minimize pelvic floor injury during the operation.The use of harmonic scalpel can mini-mize postoperative pelvic floor injury to the greatest extent.Bipolar electrocoagulation causes less injury,while monopolar electrocoagulation has a more significant impact.Clinically,it is recommended to prioritize the use of harmonic scalpel to improve postoperative quality of life.
作者
胡海玲
蔡昱
HU Hailing;CAI Yu(Department of Obstetrics and Gynecology,Hunan Prevention and Treatment Institute for Occupational Disea-ses(Affiliated Prevention and Treatment Institute for Occupational Diseases of University of South China),Changsha 410007,Hunan,China;Department of Obstetrics and Gynecolog,Hunan Provincial Hospital of in-tegrated Traditional Chinese and Western Medicine(the Affiliated Hospital of Academy of Traditional Chinese Medicine),Changsha 410006,Hunan,China)
出处
《中国现代手术学杂志》
2025年第3期248-253,共6页
Chinese Journal of Modern Operative Surgery
关键词
全子宫切除术
腹腔镜
超声刀
电凝
盆底功能
术后康复
total hysterectomy
laparoscopy
harmonic scalpel
electrocoagulation
pelvic floor functions
postoperative rehabilitation
