3种途径子宫切除术式的疗效分析

目的：通过比较3种不同途径对非脱垂子宫病变行全子宫切除术的临床效果，探讨全子宫切除术的适合途径以及各种途径的优缺点。方法分析传统的开腹全子宫切除术（TAH组）61例、腹腔镜辅助阴式全子宫切除术（LAVH 组）56例和经阴道全子宫切除术（ TVH组）50例的临床资料，对3种术式的手术时间、术中出血量、术后肛门排气时间、术后镇痛药的使用率、术后最高体温、术后并发症的发生率、住院费用、住院时间等进行回顾性对比分析。结果3组病例的术中出血量比较无明显差异， TAH组及TVH组手术时间、平均住院费用均优于LAVH组，TAH与TVH组间无明显差异；TVH及LAVH在术后肛门排气时间、术后镇痛药的使用方面均优于TAH，且TVH优于LAVH，差别有统计学意义（ P＜0．05）；TAH术后最高体温、平均住院时间高于另外两组。结论3种手术途径各有利弊，TVH及LAVH减少了患者的痛苦，但LAVH费用较高限制了其发展，TAH在复杂手术及盆腔重度粘连中仍有应用价值，故不可废弃。

Clinical analysis of three kinds of hysterectomy

Objectiv To compare the clinical effects of three kinds of hysterectomy for non-prolapsed uterus,and investigate the a-vailable way for hysterectomy,and also to compare the advantages and disadvantages of the three kinds of hysterectomy.Methods The clini-cal data of 61 cases treated with transabdominal hysterectomy( TAH group) ,56 cases treated with laparoscope assisted vaginal hysterectomy( LAVH group) and 50 cases treated with transvaginal hysterectomy ( TVH group) from Jan.to Dec.2013 in Lu'an People's Hospital were ret-rospectively analysed.The time of operation,the intraoperative bleeding loss,postoperative exhausttime,the body temperature recovery,the rate of postoperative analgesia,the incidence of complications, hospitalization and the hospitalization expenses of the three groups were compared. Results Among the three groups,there was no significant difference in the the intraoperative bleeding loss.The time of operation and the av-erage hospitalization expenses of TAH and TVH groups were less than those of LAVH groups,and there was no significant difference in TAH and TVH groups.The postoperative exhaust time and the rate of postoperative analgesia of TVH and LAVH groups were better than those of TAH group,and there was significant difference,and TVH group was better than LAVH group.The body temperature recovery and the average hospitalization of TAH group were longer than those of the others.Conclusion Three kinds of operation have their own advantages and dis-advantages.The pain of the patients get loss because of the application of TVH and LAVH.But the higher expense of LAVH limits its develop-ment and progress.TAH in complex surgery and pelvic still has application value in severe adhesion,which cannot be abandoned.