中国医科大学附属盛京医院 妇产科，辽宁 沈阳 110004
Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University , Shenyang, Liaoning 110004, China
目的 探讨垂体后叶素联合宫颈套扎法在腹腔镜子宫次全切除术（LSH）中的应用价值。方法 选择中国医科大学附属盛京医院2014年1月－2019年1月行LSH的患者249例，根据手术方式不同分为3组。常规组73例（A组）：离断宫旁组织并打开膀胱和直肠返折腹膜后，贴宫颈旁电凝闭合子宫动静脉；宫颈套扎组83例（B组）：离断宫旁组织并打开膀胱和直肠返折腹膜后，用1号可吸收线自制Roeder's线圈套扎裸化宫颈的中段，阻断子宫动静脉；垂体后叶素+宫颈套扎组93例（C组）：6 u垂体后叶素加20 mL生理盐水稀释后行宫体注射，待宫体血管收缩表面变白后再按B组的方法进行操作。比较分析3组患者手术时间、术中出血量、术后排气时间、术后腹腔引流量和术后血红蛋白下降水平等。结果 B组和C组手术时间、术中出血量、术后排气时间、术后腹腔引流量和术后血红蛋白下降水平均优于A组，C组术中出血量和术后血红蛋白下降水平均优于B组，两两比较，差异均有统计学意义（P < 0.05）；B组与C组在手术时间、术后排气时间和术后腹腔引流量等方面比较，差异均无统计学意义（P > 0.05）。术后随访3个月，3组患者均恢复良好。结论 垂体后叶素联合宫颈套扎法的LSH，能缩短手术时间、明显减少术中失血量和加快患者术后康复，使复杂手术简单化、高风险手术安全化，可有效降低副损伤发生率。
Objective To evaluate the clinical value of Pituitrin combined with cervical ligation in laparoscopic subtotal hysterectomy.Method 249 cases on which laparoscopic subtotal hysterectomy were performed from January 2014 to January 2019, were divided into three groups. The routine group of 73 cases (group A): removed parauterine tissue and open peritoneal fold of bladder and rectum, then electrocoagulate uterine artery and vein beside cervix; The cervical ligation group of 83 cases (group B): ligated uterine artery and vein in the middle of the baring cervix with Roeder's coil made by absorbable line; The Pituitrin combined with cervical ligation group of 93 cases (group C): 6 u Pituitrin diluted with 20 mL normal saline was injected into the uterus, after the contraction of the blood vessels of the uterus, the operation was performed according to group B. The operative time, operative blood loss, postoperative exhaust time, postoperative total peritoneal drainage and postoperative hemoglobin decrease were observed and compared among the three groups.Results The operative time, intraoperative blood loss, postoperative exhaust time, postoperative total peritoneal drainage and postoperative hemoglobin decrease in group B and C were better than those in group A, the intraoperative blood loss and postoperative hemoglobin decrease in group C were better than those in group B, the differences were statistically significant (P < 0.05). The operative time, postoperative exhaust time and postoperative total peritoneal drainage between the group B and C were not statistically significant (P > 0.05). All the 249 patients in the three groups were followed up for three months, all the patients recovered well.Conclusion The laparoscopic subtotal hysterectomy with Pituitrin and cervical ligation can shorten the operative time, reduce operative blood loss and accelerate the recovery of patients, simplify the complicated operation, make the high-risk operation safely and effectively reduce the incidence of various accessory injury.