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目的探讨腹腔镜手术在老年女性妇科手术中的安全性和应用价值。方法回顾性分析吉林省肿瘤医院自2014年5月-2016年5月收治的55例女性患者临床资料,包括老年腹腔镜手术组35例,老年经腹手术治疗组30例。结果患者均顺利完成手术,其中1例患者术中出现血压一过性骤降至60/40 mm Hg,给予调整后顺利完成手术。术后10例75岁以上患者转入ICU(医院规定),8例患者24 h后顺利转回疗区,另2例72 h后返回疗区。两组手术时间上比较,差异无统计学意义(P>0.05),术中出血量、术后活动时间、术后第1天体温、术后排气时间、术后进普食时间、平均住院日比较,差异有统计学意义(P<0.05)。46例患者中,Ⅰ类切口患者11例,术后发热,体温最高37.5℃,嘱患者口服抗生素3 d,均无高热感染。Ⅱ类切口患者35例,其中开腹17例,腹腔镜18例,术前30 min均常规应用抗生素预防感染,术后应用抗生素48 h,腹腔镜开腹组各1例患者出现肺部感染,给予雾化吸入化痰,嘱患者勤扣背排痰,应用抗生素达5 d。腹部切口液化,开腹组3例,腹腔镜组无切口液化感染。阴道断端感染,腹腔镜组1例,开腹组无一例。术后静脉血栓(术前明确诊断为无血栓性疾病患者),主要为下肢肌间静脉血栓,术后腹腔镜组出现1例,开腹组无一例。术后48 h无明显活动出血,给予低分子肝素钙预防血栓,常规3 d,复查D-二聚体,如明显高于正常患者,可酌情增加使用时间。术后合并高血压、糖尿病、心脏病、血栓性疾病患者,术后可按术前用药或酌情增减药量继续对症调整,均无明显加重情况。术后1、3、6个月后随访,均无慢性腹痛等远期并发症情况。结论腹腔镜手术治疗老年妇科疾病患者安全有效。
Objective To investigate the safety and application value of laparoscopic surgery in elderly female gynecological surgery. Methods The clinical data of 55 female patients admitted to Jilin Cancer Hospital from May 2014 to May 2016 were retrospectively analyzed, including 35 cases of elderly laparoscopic surgery group and 30 cases of elderly abdominal surgery group. Results All patients successfully completed the operation. Among them, one patient had sudden drop in blood pressure to 60/40 mm Hg during operation, and the operation was completed smoothly after adjustment. After operation, 10 patients over 75 years of age were transferred to the ICU (hospital regulations), 8 patients returned to the treatment area after 24 h, and the other 2 patients returned to the treatment area after 72 h. There was no significant difference in operative time between the two groups (P> 0.05), intraoperative blood loss, postoperative activity time, body temperature on postoperative day 1, postoperative exhaust time, postoperative normal food intake, average hospitalization Day, the difference was statistically significant (P <0.05). Of the 46 patients, 11 were type Ⅰ incision, with postoperative fever, the highest temperature was 37.5 ℃, and the patients were given oral antibiotics for 3 days without high fever infection. Type II incision in 35 patients, including 17 cases of laparotomy, 18 cases of laparoscopy, preoperative 30 min routine antibiotics to prevent infection, postoperative antibiotics 48 h, 1 case of laparoscopic laparotomy patients with pulmonary infection, Give inhalation of phlegm, Zhu Huanzhe buckle back Phlegm, the use of antibiotics up to 5 d. Abdominal incision liquefaction, laparotomy group 3 cases, laparoscopic group incision liquefaction infection. Vaginal stump infection, laparoscopic group 1 case, no case of open group. Postoperative venous thrombosis (preoperative diagnosis of patients without thrombotic disease), mainly lower extremity myenteric vein thrombosis, postoperative laparoscopic group appeared in 1 case, no case of open group. After 48 h, there was no significant bleeding, and low molecular weight heparin was used to prevent thrombus. Conventional D-dimer was routinely administered for 3 days. If it is significantly higher than that of normal patients, the time may be increased as appropriate. Postoperative patients with hypertension, diabetes, heart disease, thrombotic disease, postoperative medication may be preoperative or if appropriate, continue to increase or decrease the dose of symptomatic adjustment, no significant increase in the situation. After 1,3,6 months after follow-up, no long-term complications such as chronic abdominal pain. Conclusions Laparoscopic surgery for elderly patients with gynecological diseases is safe and effective.