Safety Analysis of Hysteroscopy and Laparoscopy Surgery in Patients Over 80 Years Old with Gynecological Diseases

目的 探讨80岁以上老年患者妇科疾病行宫腹腔镜手术的安全性. 方法 对我院妇科微创中心2013年1月~2017年1月宫腹腔镜手术治疗12例年龄≥80岁老年患者妇科疾病进行回顾性分析. 结果 7例宫腔镜手术时间(30.0±10.7)min,3例腹腔镜手术时间分别为30、45、65 min,1例宫腹腔镜联合手术时间为55 min,1例宫腔镜手术时间为30 min,再次腹腔镜手术时间为70 min.7例宫腔镜手术出血量为(20.0±10.7)ml,3例腹腔镜手术出血量分别为30、35、50 ml,1例宫腹腔镜联合手术出血量60 ml,1例宫腔镜手术出血量10 ml,再次腹腔镜手术出血量100 ml.7例宫腔镜手术病理:2例萎缩性子宫内膜,3例子宫内膜息肉,1例宫颈息肉,1例子宫内膜息肉和宫颈息肉;3例腹腔镜手术病理均为良性浆液性囊腺瘤;1例宫腹腔镜联合手术为萎缩性子宫内膜及良性浆液性囊腺瘤;1例为子宫内膜样腺癌(高分化).术后无前列腺电刀综合征、子宫穿孔、大出血、感染及静脉血栓性疾病等并发症.12例随访(19.8±10.7)月,未见异常. 结论 在充分评估患者手术风险的基础上,宫腹腔镜手术对于诊治80岁以上老年患者妇科疾病具有创伤小、恢复快等优点,疗效肯定,安全可行.Objective To analyze the safety of hysteroscopy and laparoscopy surgery for patients over 80 years old with gynecological diseases.Methods This investigation presented a retrospective study of 12 patients over 80 years old receiving hysteroscopy and laparoscopy surgery from January 2013 to January 2017.Results The operative time of 7 cases of hysteroscopic surgery was (30.0±10.7) min.The operative time of laparoscopic surgery was 30, 45, and 65 min, respectively.The operative time of 1 case of laparoscopy combined with hysteroscopy surgery was 55 min.The operative time of 1 case of hysteroscopic surgery was 30 min, and the secondary laparoscopic surgery was 70 min.The hemorrhage volume of 7 cases of hysteroscopic surgery was (20.0±10.7) ml.The hemorrhage volume of laparoscopic surgery was 50, 30, and 35 ml, respectively.The hemorrhage volume of 1 case of laparoscopy combined with hysteroscopy surgery was 60 ml.The hemorrhage volume of 1 case of hysteroscopic surgery was 10 ml, and the secondary laparoscopic surgery was 100 ml.The pathological diagnosis of 7 cases of hysteroscopic surgery showed 2 cases of atrophic endometrium, 3 cases of endometrial polyps, 1 case of cervical polyps, and 1 case of endometrial polyps associated with cervical polyps.The pathological diagnosis of 3 cases of laparoscopic surgery was benign serous cystadenoma.There was 1 case of atrophic endometrium and benign serous cystadenoma after laparoscopy combined with hysteroscopy surgery, and 1 case of endometrial adenocarcinoma (high differentiation).There were no complications such as transurethral resection of the prostate syndrome, perforation of uterus, bleeding, infection or venous thrombosis.Twelve patients were followed up for (19.8±10.7) months, and no abnormality was observed.Conclusion Hysteroscopy and laparoscopy surgery for the diagnosis and treatment of gynecological diseases in elderly women over 80 years old has small trauma, quick recovery and good curative effect, being safe and feasible.国家科技支撑计划; 首都卫生发展科研专项; 北京市医院管理局临床医学发展专项中国科学引文数据库(CSCD)7623-6261