腹腔镜与阴式子宫全切术对盆底功能的影响

目的：探讨经阴道子宫切除术（TVH）、腹腔镜下子宫切除术（LTH）、与腹腔镜辅助下阴式子宫全切术（LAVH）三种术式对盆底功能的影响。方法：216例非脱垂子宫全切术患者随机分为3组,分别接受TVH、LTH与LAVH手术。术后系统随访。评价术后6个月时的阴道脱垂程度、膀胱和直肠膨出程度、压力性尿失禁情况和盆底肌肉肌力。结果：TVH组、LTH组、LAVH组阴道脱垂分别为2例（2.8%）、1例（1.4%）、1例（1.4%）（P〉0.05）;膀胱和直肠膨出分别为3例（4.2%）、1例（1.4%）、2例（2.8%）（P〉0.05）;压力性尿失禁分别为4例（5.6%）、2例（2.8%）、3例（4.2%）（P〉0.05）;TVH组盆底肌肉肌力最弱（P〈0.05）,而LTH组与LAVH组两组间肌力相似。结论：3种子宫切除术对盆底功能影响均较小;而腹腔镜下子宫切除术与腹腔镜辅助下阴式子宫全切术对盆底肌肉肌力影响更小;而腹腔镜辅助下阴式子宫全切术难度较小,更值得推荐。

The effects of pelvic floor function after laparoscopic assistant vaginal hysterectomy

Objective：To evaluate the effects of pelvic floor function after vaginal hysterectomy（TVH）,laparoscopic hysterec tomy（LTH） and laparoscopically assisted vaginal hysterectomy（LAVH）.Methods：216 patients with non-prolapse hysterectomy were randomly divided into three groups receiving TVH,LTH and LAVH surgery,respectively.After 6 months follow-up,the degree of vaginal prolapse,the degree of bladder and rectum prolapse,stress urinary incontinence and pelvic floor muscle strength conditions were evaluated.Results：The vaginal prolapse in TVH group,LTH group,LAVH group were two patients（2.8%）,one patient（1.4%）,and one patient（1.4%）（P0.05）,respectively;bladder and rectal prolapse in there groups were three patients（4.2%）,one patient（1.4%）,and two patients（2.8%）（P0.05） respectively;stress urinary incontinence in there groups were four patients（5.6%）,two patients（2.8%）,and three patients（4.2%）（P0.05）,respectively.But patients in TVH group had weakest pelvic floor muscle strength（P0.05）,while the LTH group and the LAVH group had similar strength between the two groups.Conclusion：The pelvic floor function is less affected in these three hysterectomy;the pelvic floor muscle strength were less impact after laparoscopic hysterectomy and laparoscopically assist ed vaginal hysterectomy;laparoscopic assisted vaginal hysterectomy is easier,which is more recommended.