腹腔镜辅助阴式子宫切除术与阴式子宫切除术适应证的探讨

目的通过比较腹腔镜辅助阴式子宫切除术(LAVH)与阴式子宫切除术(VH)的不同手术适应证及效果,探讨LAVH与VH手术病人的最佳选择。方法回顾性分析上海瑞金医院1999年6月至2002年12月间LAVH与VH手术病例381例,比较两种手术在手术时间、出血量、术后住院日、术中术后并发症及两者的手术适应证,尤其是子宫大小、盆腔粘连等的不同。结果两组手术在术中出血、手术并发症等方面差异无显著性意义,LAVH手术时间较长与患者子宫大、盆腔粘连者多、手术难度大有关。VH组患者均为正常或小于正常大小的子宫、无盆腔粘连、不伴有附件疾病者,手术适应证明显受限制。结论VH与LAVH均为创伤小、恢复快的微创手术,但VH适合于子宫小、无粘连并伴下垂者,而LAVH扩大了VH的适应证,是值得推广的手术。

The discussion of the indications of laparoscopically assisted vaginal hysterectomy and vaginal hysterectomy

Objective To compare the surgical indications and outcomes of patients undergoing laparoscopically assisted vaginal hysterectomy (LAVH) and vaginal hysterectomy (VH), in order to offer the best treatment to our patients. Methods We retrospectively studied 381 cases with LAVH and VH performed at Gynecology Department of Ruijin Hospital of Shanghai from June 1999 to December 2002, and evaluated the operation time, hemorrhage, postoperative hospitalization period, intraoperative and postoperative complications, and indications for surgery especially on uterine size, pelvic adherence condition between these two surgical techniques. Results There was no significant difference in the frequency of hemorrhage, duration of recuperation, and surgical complications between the 2 groups. Operative time was longer in LAVH group that seemed related to uterine size, serious pelvic adherence, and surgical difficulty. Patients who had normal or small uterus without pelvic adherence or adnexal diseases underwent a VH,in which surgical indication was limited.Conclusion LAVH and VH are minimal invasive surgeries that include reduced pain, quicker short-term recuperation. But VH only can be used for the prolapse of small uterus without pelvic adherence. LAVH expands the indication of transvaginal hysterectomy, and should be recommended widely.