经腹、经阴道、腹腔镜全子宫切除术临床对比研究

目的 探讨经腹全子宫切除术(TAH)、非脱垂子宫经阴道全子宫切除术(TVH)、腹腔镜辅助阴式全子宫切除术(LAVH)的临床特点及临床价值.方法 对上海市长宁区妇幼保健院2004年7月至2006年12月因子宫良性疾病需行子宫切除术的335例病例进行回顾性分析,其中TAH组118例、TVH组80例、LAVH137例,观察3组手术时间、术中出血情况、术后镇痛、术后病率和住院时间.结果 LAVH组手术时间[(130.6±37.7)min]分别较TVH[(78.9±27.8)min]、TAH组[(88.1±32.4)min]延长(P＜0.01),而后两者差异无统计学意义;LAVH组术后第1天血红蛋白下降[(9.3±7.6)g/L]分别显著高于TAH、TVH组(P＜0.01),后两者差异无统计学意义;TAH组术后镇痛率(63.6%)分别显著高于TVH、LAVH组(P＜0.05),后两者差异无统计学意义;住院时间TVH组[(6.4±1.8)d]与LAVH、TAH组差异有统计学意义(P＜0.01).3组术后病率比较差异无统计学意义(P＞0.05).结论 TVH术式手术时间短、出血少,兼有TAH和LAVH的优点,子宫体积小于4个孕月时可采用该术式.临床应根据不同情况选择不同的子宫切除方式以达到最佳治疗效果.     

4种子宫全切术式在肥胖患者中的应用

目的:评价肥胖患者经腹子宫全切术(TAH)、经阴道子宫全切术(TVH)、腹腔镜辅助阴式子宫全切术(LAVH)和经腹腔镜下子宫全切除术(TLH)4种手术的临床效果.方法:回顾分析338例采用TAH、TVH、LAVH、TLH 4种术式行子宫切除术的手术时间、术中出血量、术后恢复情况.结果:TAH组手术时间明显长于其他3组(P均<0.01);LAVH组与TVH组、TLH组比较,差异有统计学意义(P<0.01);TVH组与,TLH组比较差异无统计学意义(P>0.05).TAH组术中出血量多于其他3组(P均<0.01);TVH组多于LAVH组(P<0.01).与TLH组相比差异无统计学意义(P>0.05),TLH组多于LAVH组(P<0.05).TAH组术后排气时间、术后前3天平均体温、术后住院时间与其他3组比较差异均有统计学意义(P均<0.01);TVH组、LAVH组及TLH组3组比较,差异均无统计学意义(P均>0.05).结论:4种术式均为肥胖患者子宫全切除的有效术式,应根据患者病情、医生的技术条件及现有设备来选择适宜的方法.     

4种子宫切除术式的临床应用

目的:评价经腹全子宫切除术(TAH),阴式子宫切除术(TV8),腹腔镜辅助下阴式子宫切除术(LAVH)及腹腔镜下全子宫切除术(LTH)4种术式的临床应用效果.方法:回顾性分析TAH 60例,TVH 38例,LAVH 32例,LTH25例的临床资料.结果:4组患者无并发症发生,手术时间LTH组(119.24±12.3分钟)显著长于TVH组(76.67±8.86分钟)、TAH组(86.62±18.98分钟)和LAVH组(92.48 ±14.84分钟);术中出血量TAH组(158.28±50.38 ml)多于TVH组(90.72 ±60.28 ml)、LAVH组(80.89 ±16.24 ml)和LTH组(89.92 ±20.32 ml);术后排气时间TAH组(38.26 ±13.45小时)显著长于TVH组(25.72 ±2.43小时)、LAVH组(21.02±4.83小时)和LTH组(22.24±6.84小时);术后镇痛率TAH组(91.7%)显著高于TVH组(21.1%)、LAVH组(12.5%)和LTH组(24.0%).术后住院时间TAB组(9.24±0.98天)显著长于,TVH组(5.32±0.83天)、LAVH组(4.02±0.40天)和LTH组(4.24± 0.08天).结论:TVH、LAVH和LTH创伤小、患者痛苦少、术后恢复快.4种术式均为子宫切除的有效术式,各有利弊,根据患者的具体情况选择合适手术.     

腹腔镜下不同子宫切除术2272例临床分析

目的　评价腹腔镜鞘膜内子宫切除术 (LISH)、腹腔镜子宫次全切除术 (LSH)、腹腔镜全子宫切除术(LTH)和腹腔镜辅助阴式子宫切除术 (LAVH)4种术式的临床效果。方法　回顾性分析各种腹腔镜子宫切除术 2272例的手术时间、出血量、并发症及术后恢复情况等。结果　保留子宫颈的两种术式中,LISH1323例(LISH组),手术时间为(91±21)min,出血量为 (93±23)ml,并发症发生率为 4 1%;LSH229例(LSH组),手术时间为(70±18)min,出血量为 (69±17)ml,无一例并发症发生;LISH组的手术时间、出血量及并发症发生率均高于LSH组,差异有统计学意义 (P<0.01)。去除子宫颈的两种术式中,LAVH588例(LAVH组),手术时间为(119±28)min,出血量为 (156±23)ml,并发症发生率为 1 0%;LTH132例(LTH组),手术时间为 (121±30)min,出血量为 (193±38)ml,并发症发生率 1 5%;LAVH组的手术时间、并发症发生率与LTH组比较,差异无统计学意义(P>0.05),而术中出血量LTH组明显多于LAVH组,差异有统计学意义(P<0.01)。结论　4种术式均为腹腔镜下子宫切除的有效术式,且各有利弊;应根据患者的具体情况选择适宜术式。     

阴式与腹腔镜子宫全切除术的临床效果比较

目的比较阴式子宫全切除术和腹腔镜子宫全切除术的临床效果。方法收集我院2002年1月至2004年6月接受以上不同途径子宫切除术的病例共301例的临床资料,其中阴式子宫全切除术197例(阴式组),腹腔镜子宫全切除术104例(腹腔镜组),比较两组疾病种类、手术时间、术中出血量、住院时间、医疗费用及术后恢复情况等。结果(1)疾病种类:宫颈非典型增生阴式组19例、腹腔镜组3例;子宫腺肌病、合并附件疾病或盆腔子宫内膜异位症,阴式组分别为58例、9例、8例,腹腔镜组分别为45例、33例、13例;(2)手术时间:阴式组(76±28)min、腹腔镜组(139±52)min;(3)术中出血量:阴式组(170±125)ml、腹腔镜组(206±153)ml;(4)肌瘤或腺肌瘤最大直径:阴式组(49±17)mm、腹腔镜组(57±22)mm;(5)手术费用:阴式组(1073±203)元、腹腔镜组(1526±676)元。以上各指标两组比较,差异均有统计学意义(P<0·05);(6)住院时间:阴式组(5·6±1·2)d、腹腔镜组(5·7±2·4)d;(7)子宫重量:阴式组(235±115)g、腹腔镜组(256±158)g;(8)手术并发症发生率:阴式组为2·54%、腹腔镜组为2·88%。住院时间、切除子宫重量及手术并发症发生率等两组比较,差异均无统计学意义(P>0·05)。结论无明显盆腔粘连和附件疾病的子宫全切除术可选择阴式途径,子宫大小并非选择术式的决定因素。     

不同术式大子宫全切除术临床效果分析

目的 评价大子宫经腹全子宫切除(TAH),经阴道全子宫切除术(TVH),腹腔镜辅助阴式子宫切除(LAVH)以及全腹腔镜下子宫切除(TLH)4种术式的临床效果.方法 对解放军260医院2002年1月至2007年6月246例患者采用4种术式切除大子宫的手术时间、术中出血量、术后恢复情况进行回顾性分析.结果 手术时间TAH组[(101±24)min]短于TVH组[(132±25)min]、LAVH组[(111±21)min]及TLH组[(120±22)min](P＜0.01、P＜0.05);TVH组手术时间长于2种腹腔镜组(P＜0.01、P＜0.05),2种腹腔镜组手术时间相比TLH长于LAVH组(P＜0.01).术中出血量TAH组[(148±66)mL]多于TVH组[(125±70)mL]、LAVH组[(110+65)mL]及TLH组[(122±66)mL](P均＜0.05);TVH组、LAVH组、TLH组间相比差异无统计学意义(P均＞0.05).4组术后情况相比,排气时间TAH组[(41±16)h]长于TVH组[(25±6)h]、LAVH组[(23±5)h] 及TLH组[(24±7)h](P均＜0.01);TVH组排气时间长于LAVH组(P＜0.05),但与TLH组相比差异无统计学意义(P＞0.05);2种腹腔镜组相比无差异(P均＞0.05).术后住院时间TAH组[(6.5 ±0.8)d]长于TVH组[(3.6±0.5)d]、LAVH组[(3.7±0.4)d]及TLH组[(3.5±0.7)d](P均＜0.01);TVH组、LAVH组及THL组间相比差异均无统计学意义(P均＞0.05).结论 4种术式均为大子宫切除的有效术式,且各有利弊;应根据患者的具体情况,术者的技术状况选择适宜术式.     

非脱垂子宫阴式与腹腔镜辅助下阴式全切术临床应用研究

目的:探讨经阴道、经腹腔镜辅助的阴式非脱垂子宫切除手术在临床应用的效果。方法:对患子宫良性病变有手术指征的非脱垂子宫患者181例,66例行腹式子宫切除手术(TAH)组,60例行阴式子宫切除手术(TVH)组,55例行腹腔镜辅助阴式子宫切除术(LAVH)组,对比分析各组的临床治疗效果。结果:TVH组、LAVH组术后肛门排气时间、住院天数均比TAH组少;LAVH组手术时间较TVH组、TAH组明显延长,手术费用较后两组高;TAH组术中出血量较TVH组、LAVH组明显增加。结论:经阴道、经腹腔镜辅助的阴式非脱垂子宫切除手术具有创伤小、恢复快、住院时间短等优点,符合微创手术原则,值得推广。     

常用全子宫切除术的术式及其选择

有关子宫切除术式选择的指征尚无统一意见。阴式全子宫切除术(TVH)具有创伤小、恢复快、术后疼痛轻和经济等优点，可作为全身情况较差或特别肥胖者的首选术式。腹腔镜辅助阴式子宫切除术(LAVH)的手术指征与腹式全子宫切除术(TAH)相同，LAVH具有TVH的多数优点，但费用较贵。TAH则有良好的手术视野，操作方便，易进行快速止血，当TVH或LAVH无法完成时，应及时改行TAH。     

常用全子宫切除术的术式及其选择

有关子宫切除术式选择的指征尚无统一意见。阴式全子宫切除术（TVH）具有创伤小、恢复快、术后疼痛轻和经济等优点，可作为全身情况较差或特别肥胖者的首选术式。腹腔镜辅助阴式子宫切除术（LAVH）的手术指征与腹式全子宫切除术（TAH）相同，LAVH具有TVH的多数优点，但费用较贵。TAH则有良好的手术视野，操作方便，易进行快速止血，当TVH或LAVH无法完成时，应及时改行TAH。     

腹腔镜下子宫切除术治疗子宫肌瘤1163例临床研究

目的　探讨腹腔镜子宫切除术式的临床价值。方法　对腹腔镜鞘膜内子宫切除术 (LISH) 771例、腹腔镜协助阴式子宫切除术 (LAVH) 372例、腹腔镜下全子宫切除术 (LTH ) 2 0例进行回顾性分析。结果　LISH、LAVH、LTH三组的手术时间分别为 (10 7 6 8± 2 9 2 8)min、(119 6 5± 2 9 93)min、(178 2 5± 32 89)min。LISH组的手术时间明显少于LAVH与LTH组 (P <0 0 1)。出血量分别为 (10 0 19± 2 2 0 6 )mL、(15 5 13± 2 4 5 4 )mL、(2 5 6 0 0± 10 7 6 3)mL ,LISH组的出血量明显少于LAVH组与LTH组 (P <0 0 1)。术中脏器损伤率 :LISH组0 2 6 % (2 / 771) ,LAVH组 0 2 7% (1/ 372 )。三组术后 3天体温分别为 (37 5± 0 3)℃、(38 1± 0 4 )℃、(37 8±0 6 )℃ ,LISH的术后体温明显低于LAVH组 (P <0 0 1)。三组术后肛门排气时间分别为 (32 2 8± 0 6 3)h、(39 4 0± 8 5 5 )h、(38 30± 16 31)h ,LISH组术后肛门排气时间明显早于LAVH组 (P <0 0 1)。三组平均住院日分别为 (4 1± 0 3)d、(4 7± 0 6 )d、(4 1± 0 4 )d ,LISH组术后住院日明显短于LAVH组 (P <0 0 1)。结论　三种术式均可作为临床子宫切除的术式之一。为保留器官、提高患者生存质量 ,<5 0岁患者宜采用LISH ,≥ 5 0岁可考虑L     

Observational comparison of abdominal, vaginal and laparoscopic hysterectomy as performed at a university teaching hospital

OBJECTIVE: To compare short-term outcomes of total abdominal hysterectomy (TAH) to total vaginal hysterectomy (TVH) and laparoscopic hysterectomy (LH) regarding operative time, estimated blood loss, postoperative pain, recovery milestones, complication rates, hospital stay, hospital costs and patient satisfaction. STUDY DESIGN: A prospective, observational study examined the above criteria for 177 women with the following distribution of hysterectomy type: TAH (n = 50, 28%), TVH (n = 76, 43%) and LH (n = 51, 29%). RESULTS: Operative time was shortest for TVH (103 minutes), followed by TAH (127 minutes), and longest for LH (157 minutes) (p = 0.000). Blood loss was significantly higher in the TAH groups as compared to the TVH and LH groups. Pain estimates and analgesia requirements were significantly lower for the LH and TVH groups as compared to the TAH group. Recovery milestones were met significantly earlier in the TVH and LH groups. Complication rates did not differ significantly between the groups. Hospital stay was significantly longer for the TAH group (3.7 days) than for the TVH (1.9 days) and LH (1.5 days) groups. Hospital costs were significantly lower for the TVH groups as compared to TAH and LH groups. No significant cost difference was seen between TAH and LH. Satisfaction rates did not differ significantly between the groups though a greater percentage of patients in the LH group reported high satisfaction as compared to the other groups. CONCLUSION: Vaginal hysterectomy remains the most cost-effective approach; laparoscopy's role may be best suited to allowing conversion of laparotomy cases to a vaginal approach with assistance of a laparoscope.     

Laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy: a study of 100 cases on light-endorsed transvaginal section

The objective of this study was to compare the results of a modified laparoscopically assisted vaginal hysterectomy (LAVH) procedure, using light-endorsed transvaginal section by two puncture trocars, with those of total abdominal hysterectomy (TAH) in a prospective, randomized, short-term study. A new, modified LAVH technique using Endo GIA stapler and two puncture trocars was established. For the laparoscopic phase, each adnexum was dissected, and the vesicouterine junction was identified clearly with the laparoscopic light from the vaginal side. Vaginal-phase surgery was performed as usual. Two hundred patients scheduled for abdominal hysterectomy were randomized to either LAVH (n = 100) or TAH (n = 100). Duration of hospitalization, time of surgery, dose of analgesics, and rates of complications were significantly lower in the LAVH group (p < 0.001). The average operating time was 77 +/- 30 min for LAVH and 102 +/- 18 min for TAH. The duration of hospitalization was 3.2 +/- 0.7 days for LAVH and 5.5 +/- 1.3 days for TAH. There were three complications in the LAVH group and 15 in the TAH group. Postoperative meperidine requirements (1.2 vs. 3.7 ampoules, 1 ampoule = 50 mg) were significantly fewer in the LAVH group. Regarding the training time, the mean operating time in the first 20 cases was 98 min, and in the last 20 cases it was 70.9 min. As compared with TAH and other modified LAVH procedures reported previously, the present technique is easy to learn and timesaving with fewer complications.     

三种不同全子宫切除术式对患者围手术期生活质量的影响和卫生经济学研究

目的 观察经腹全子宫切除术(TAH)、腹腔镜下全子宫切除术(LH)和经阴道全子宫切除术(TVH)3种不同术式对患者围手术期生活质量的影响和卫生经济学研究。方法 应用世界卫生组织生活质量测定量表简表,对3组(TAH组,19例;LH组,20例;TVH组,13例)患者分别在术前、术后第4天、术后第14天和术后第28天进行生活质量评估;以术前和术后28 d内门诊和(或)急诊就诊医药费,住院费用,门诊和(或)急诊就诊、住院和术后恢复期间,患者和家人工作岗位上收入的损失和门诊和(或)急诊就诊、住院和术后恢复期间,与手术相关的、支付他人的佣金等4方面计算手术总费用;以术前和术后28 d内,在门诊和急诊就诊次数以及住院天数,计算对卫生资源的消耗。结果(1)术后第4天生活质量评分,TVH组为(93±6)％,LH组为(85±10)％,TAH组为(81±11)％,TVH组与TAH组比较,差异有极显著性(P<0.01);术后第14天生活质量评分,TVH组为(95±7)％,LH组为(96±7)％,TAH组为(85±9)％;术后第28天生活质量评分,TVH组为(96±10)％,LH组为(98±7)％,TAH组为(87±10)％;TVH组及LH组组间比较,差异均无显著性,但与TAH组比较,差异均有显著性(P<0.01、P<0.01)。(2)术前和术后28 d内,门诊和急诊就诊医药费,TVH组为(838±211)元,高于LH组的(583±50)元和TAH组的(568±31)元;     

Comparison of laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy: a randomized controlled trial

ObjectiveTo compare intraoperative hemorrhage and other operative parameters after laparoscopically assisted vaginal hysterectomy (LAVH) versus total abdominal hysterectomy (TAH) for benign gynecologic conditions.DesignA prospective, randomized, controlled trial.Materials and MethodsBetween April 2010 and March 2011, 50 Thai patients with strong indications for hysterectomy—with uterine sizes ≤16 weeks of gravid uterus and with no contraindications for open or laparoscopic surgeries—were randomly assigned for LAVH or TAH.Main Outcome MeasuresIntraoperative blood loss, operating time, postoperative analgesic requirements, perioperative complications, and duration of hospitalization.ResultsIntraoperative blood loss was significantly less in the LAVH group (median 120 mL [range 50–300]) than in the TAH group (median 250 mL [105–800]) (median difference 130 mL, p <.001, 95% confidence interval [CI] 55–200). The LAVH group required significantly less postoperative morphine sulfate administration (median 3 mg [range 0–12]) than the TAH group (15 mg [6–24]) (median difference 9 mg, p <.001, 95% CI 9–12). The hospital stay for the LAVH group (median 3 days; range 2–7) was significantly shorter than that of the TAH group (median 4 days; range 4–5) (median difference 2 days, p <.001, 95% CI 1–2). The operating time was comparable between the 2 groups (median 100 minutes; range 50–240) for the LAVH and 115 minutes (range 60–200) for the TAH group (median difference 5 minutes, p =.592, 95% CI ?15–25). There were no conversions from a LAVH to a laparotomy.ConclusionsThe LAVH has advantages over the TAH in that in the former there is less intraoperative blood loss, less postoperative morphine requirement, and a shorter duration of postoperative hospital stays.     

A comparison of laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy

The goal of this study was to compare laparoscopically assisted vaginal hysterectomy (LAVH) with total abdominal hysterectomy (TAH). We performed a prospective comparison of the hospital courses of 30 women, 15 undergoing LAVH and 15 undergoing TAH, in a teaching hospital setting. Analysis of variance (ANOVA) was used, with statistical evaluation of differences by Student's t-test for normally distributed data and Kruskal-Wallis for data with dissimilar variances. Fourteen of fifteen patients scheduled for LAVH had their surgery completed without need of a laparotomy. In the LAVH group, (1) mean surgical time was 50 minutes longer, (2) blood loss, complications, and hospital costs were not statistically different, (3) hospital days averaged 1 1/2 less, and (4) postoperative pain ratings and medication requirements were significantly decreased, compared with the TAH group. In many cases, LAVH may be reasonably performed instead of an indicated TAH.     

Assessing the impact of introducing laparoscopically assisted vaginal hysterectomy into a community-based gynecology practice

This study was undertaken to determine the effects of introducing laparoscopically assisted vaginal hysterectomy (LAVH) into a community-based gynecology practice on the route of hysterectomy, operating time, patient costs, length of hospitalization, and morbidity, including complications and blood loss. All patients in the author's practice who had hysterectomies during the 10 months before completion of an advanced operative laparoscopy course were compared with the patients having a hysterectomy in the 10 months after the course. The route of hysterectomy, surgery time, length of hospital stay, preoperative and postoperative hemoglobin, uterine weight, diagnoses, and historical clinical data were compared between the two groups using a level of significance (alpha = 0.01) to assess statistical relevance. The rate of vaginal hysterectomy was remarkably higher in the AFTER group (53.2%, n = 62) vs the BEFORE group (27.7%, n = 65). The AFTER group had a significantly shorter hospital stay (3.4 days +/- 1.22 vs 4 days +/- 1.26, p < or = 0.01) but a much longer surgery time (115.9 min +/- 38.98 vs 80.1 min +/- 27.95, p < or = 0.01). There was no real difference in complication rates or fall in hemoglobin between the two groups. When LAVH was compared with TAH, the LAVH patients tended to be younger (37.4 +/- 8.66 vs 46.2 +/- 16.5 years) and to have a shorter hospital stay (3.1 +/- 0.99 vs 4.1 +/- 1.27 days), a longer surgery time (114.9 +/- 37.45 vs 85.3 +/- 33.74 min), and a bigger hospital bill ($6245 +/- 380 vs $5140 +/- 410) than patients with TAH.(ABSTRACT TRUNCATED AT 250 WORDS)     

腹腔镜辅助下的阴式子宫切除临床分析

目的:探讨腹腔镜辅助下的阴式子宫切除术(LAVH)的手术要点及临床应用价值。方法:将我院自2008年7月至2009年6月收治的需行子宫切除术的患者100例,其中50例行LAVH,另外50例行传统开腹式子宫切除(TVH)术。对两组患者的手术时间、出血量、术后恢复及并发症情况进行比较分析。结果:50例行LAVH患者,2例中转开腹手术,手术成功率为96.0%;其平均手术时间、出血量、平均住院时间均显著优于TAH,P0.05。结论:腹腔镜辅助阴式子宫切除术具有安全性高?术后恢复快?损伤性小?并发症少?住院时间短的优点。     

Short- and long-term clinical results of laparoscopic-assisted vaginal hysterectomy and total abdominal hysterectomy

STUDY OBJECTIVE: To compare short- and long-term clinical results of laparoscopic-assisted vaginal hysterectomy (LAVH) and total abdominal hysterectomy (TAH). DESIGN: Retrospective cohort study (Canadian Task Force classification II-1). SETTING: University-affiliated hospital. PATIENTS: One hundred fifty women who underwent LAVH and 146 who underwent TAH. INTERVENTION: Hysterectomy. MEASUREMENTS AND MAIN RESULTS: Blood loss during surgery, narcotic analgesic consumption, duration of hospital stay, and convalescence time were significantly higher for women who underwent TAH than for those who underwent LAVH (p <0.05). Operating time was significantly longer for LAVH than for TAH (152.2 +/- 32.4 vs 96.5 +/- 29.6 min, p = 0.014). Eight-year follow-up showed no statistically significant differences in vaginal vault prolapse, cystocele, rectocele, enterocele, postcoital spotting, and cuff granulation between procedures (p >0.05). CONCLUSIONS: Although short-term clinical results revealed some statistically significant differences between LAVH and TAH, long-term follow-up recorded similar frequencies of surgical sequelae.