| Background: With the development of the society,the proportion of the elderly people increases year by year,and the age limit is defined as the 65 years old in epidemiology,but in the clinical study more clinicians define 70 years old as the lower limit of elderly patients with screening,because there are reports that the body function of each organ system decreases obviously on the people who age over 70 years old,which is widely considered to be the age limit of the body's aging.As the age increases,the function of the organs,tissues and systems of the body gradually decreases,and the ability of the external stress decreases,so does the operation.With the extensive use of laparoscopy,there is still a lot of debate about whether the field of gynecology can be applied to older patients.Objective: By the clinical comparison and analysis of the laparoscopic surgery and traditional open surgery in the treatment of gynecologic benign diseases of the older patients,to explore the safety of the laparoscopic on the patients who aged over 70 diagnosed the benign diseases of department of gynaecology,which provides the basis for clinicians to select the right surgical methods.Methods: Retrospect analysis of the women patients who aged 70 or higher hospitalized in the First Affiliated Hospital of Zhengzhou University since January 1,2005 to December 31,2010 which been diagnosed of the benign diseases of department of gynecology who chose the laparoscopic hysterectomy and bilateral adnexectomy,not including the patients with the uterine prolapse and vaginal prolapse,collecting the information of the cases whose medical records were intact,and the amount is 170 cases.It could be divided into two groups,which one group of them is laparoscopic group which account for 90 cases and the other is laparotomy group which account for 80 cases.Analyze the two groups of patients with the age,the classification of diseases,the complications,the history of pelvic surgery in the past,average days of hospitalization before operation,operation time,the amount of bleeding during the surgery,intraoperative complications,anal exhaust time in the postoperative,the time of returning to normal diet,the time of off-bed activity,the time of the usage of antibiotics in the postoperative,the analgesia drug usage of antibiotics in the postoperative,postoperative morbidity,venous thrombosis in the postoperative,afteroperative complications,the average length of hospital stay after surgery and the total cost in the hospital,and to explore whether there exist certain differences between them,and the difference is or not statistically significant,at the same time to konw the security of the laparoscopic surgery in elderly women who aged over 70.Results:(1)The surgeries of the total 170 patients were successfully completed,and none of the laparoscopic surgery transfer laparotomy,and the success rate of 100%.(2)the preoperative general situations of the two groups: there was no significant statistical differences of the two groups on the age,the classification of diseases,the complications,the history of pelvic surgery in the past,average days of hospitalization before operation.(3)the intraoperative situations of the two groups:the average operation time of the patients in the laparoscopic group was(63.37±8.32)min which significantly less than the laparotomy surgery time(104.20±29.91)min(t=-12.957,P=0.000);the amount of bleeding of the laparoscopic group was(36.78±13.93)ml which significantly less than the open surgery group(130.31±83.19)ml(t=-8.158,P=0.000);laparoscopic group patients appear no unusual complications,however there was one patient in the laparotomy group who hemorrhaged about 800 ml and in the operation infused suspended red blood cells 4 u and the frozen blood plasma 200 ml to ease the crisis.(4)the afteroperative situations of the two groups:the patients postoperative anal exhaust time of the laparoscopic group was(1.48±0.97)d which significantly less than the open surgery group(2.36±0.78)d(t=-6.472,P=0.000);the time of returning to normal diet after operation of the laparoscopic group was(1.57±1.11)d which significantly less than the open surgery group(2.79±1.56)d(t=-5.931,P=0.000);the time of off-bed activity of the laparoscopic group was(1.09±0.66)d which significantly less than the open surgery group(2.19±1.24)d(t=-6.600,P=0.000);the time of the usage of antibiotics in the postoperative of the laparoscopic group was(3.08±2.09)d which significantly less than the open surgery group(4.55±2.14)d(t=-4.435,P=0.000);the analgesia drug usage of antibiotics in the postoperative of the laparoscopic group was 16.7% which significantly less than the open surgery group 71.3%(?2=51.682,P=0.000);venous thrombosis in the postoperative of the aparoscopic group was 2 patients(2.3%)which significantly less than the open surgery group 9 patients(11.3%)(?2=5.704,P=0.017);the average length of hospital stay after surgery of the laparoscopic group was(5.70±2.51)d which significantly less than the open surgery group(8.65±3.22)d(t=-6.706,P=0.000);the postoperative morbidity of laparoscopic group was4.4% and the postoperative morbidity of the open group was11.3%,so there was no statistically difference(?2=2.778,P=0.096);the total cost in the hospital of the laparoscopic group was(24109.81±5350.06)yuan which significantly less than the open surgery group(14066.75±6801.47)yuan(t=10.757,P=0.000);afteroperative complications:one patient occur intestinal obstrution in the laparoscopic group;the surgical incision of two patients unhealed and intestinal obstrution of three patients in the open surgery group.Conclusion Laparoscopy have unique advantages about the small trauma,less pain,few complication and high safety in the hysterectomy and bilateral adnexectomy of the patients who aged 70 or higher which been diagnosed of the benign diseases of department of gynecology.But the cost of the laparoscopy is higher than the laparotomy,yet to be improved. |
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