中国现代医学杂志2025，Vol.35Issue(21)：78-85,8.DOI:10.3969/j.issn.1005-8982.2025.21.013
经阴道单孔腹腔镜与经脐单孔腹腔镜子宫全切术近期疗效及术后盆底功能障碍的高危因素分析
Analysis of short-term efficacy and risk factors of pelvic floor dysfunction after total hysterectomy by transvaginal and transumbilical single-hole laparoscopy
摘要
Abstract
Objective To investigate the short-term efficacy of transvaginal laparoendoscopic single-site hysterectomy(v-NOTES)and transumbilical laparoendoscopic single-site hysterectomy(u-LESS),and to analyze the influencing factors of postoperative pelvic floor dysfunction(PFD).Methods A total of 156 patients who needed total hysterectomy in our hospital from March,2021 to March,2023 were retrospectively selected and divided into u-LESS group(n=62)and v-NOTES group(n=94)according to the surgical method.The general data of all patients,such as age,body mass index(BMI),menopause,induced abortion history,gravidity and parity,the first time of postoperative weight-bearing and the first time of postoperative sexual life,were collected and recorded.The operation time,intraoperative blood loss,indwelling catheter time,anal exhaust time,hospital stay and other perioperative indicators were recorded.Visual analogue scale(VAS)was used to evaluate the postoperative pain,and the short-term efficacy and the incidence of PFD were compared between the two groups.Logistic regression was used to analyze the risk factors of PFD.Results The operation time,indwelling catheter time and anal exhaust time in the v-NOTES group were all shorter than those in the u-LESS group(P<0.05).(1)There were statistically significant differences in the VAS scores at rest at 6 h,12 h and 24 h after surgery between the u-LESS group and the v-NOTES group(F=219.021,P=0.000).(2)There were also statistically significant differences in the VAS scores at rest between the u-LESS group and the v-NOTES group(F=40.000,P=0.000).The VAS score at rest in the v-NOTES group was lower than that in the u-LESS group,indicating a better analgesic effect.(3)There wasn't a statistically significant difference in the total effective rate between the u-LESS group and the v-NOTES group(F=0.444,P=0.642),and the total effective rate in the v-NOTES group was higher than that in the u-LESS group(P 0.05).There was no statistically significant difference in the total incidence of PFD between the u-LESS group and the v-NOTES group(P<0.05).There were statistically significant differences in age,BMI,parity and the time of first postoperative weight-bearing between the PFD group and the non-PFD group(P<0.05).Advanced age[O^R=1.191(95%CI:1.036,1.369)],high BMI[O^R=1.196(95%CI:1.059,1.351)],multiple pregnancies and deliveries[O^R=1.198(95%CI:1.057,1.359)],and the time of first postoperative weight-bearing≤3 months[O^R=1.372(95%CI:1.082,1.739)]were all risk factors for PFD after total hysterectomy(P<0.05).The area under the curve of the logistic regression model was 0.877,with a sensitivity of 80.56%(95%CI:0.763,0.845)and a specificity of 82.58%(95%CI:0.732,0.886).Conclusions The incidence of PFD after total hysterectomy is affected by the patient's age,BMI,gravidity,parity and the time of first weight-bearing after operation.The prediction model based on logistic regression has certain predictive value for the occurrence of PFD after total hysterectomy.v-NOTES and u-LESS do not affect the incidence of postoperative PFD.However,v-NOTES can reduce the pain of patients and has better curative effect.关键词
经阴道单孔腹腔镜/经脐单孔腹腔镜/子宫全切术/盆底功能障碍Key words
vaginal natural orifice transluminal endoscopic surgery/umbilical laparoscopic single-site surgery/total hysterectomy/pelvic floor dysfunction分类
临床医学引用本文复制引用
刘明敏,黄如亮,王宇辰,薛华..经阴道单孔腹腔镜与经脐单孔腹腔镜子宫全切术近期疗效及术后盆底功能障碍的高危因素分析[J].中国现代医学杂志,2025,35(21):78-85,8.基金项目
徐州市卫生健康委员会项目(No:XWKYHT20220099) （No:XWKYHT20220099）
