非脱垂子宫阴式子宫全切除术的适应证和禁忌证探讨

目的探讨非脱垂子宫阴式子宫全切除术(TVH)的适应证和禁忌证。方法回顾性分析我院1992年6月至2003年6月间2086例非脱垂子宫TVH的临床资料,按子宫体积、既往有无盆腹腔手术史、有无阴道分娩史、是否同时处理附件等分别进行统计,比较手术并发症的发生情况。结果(1)不同体积子宫比较:子宫体积>16孕周患者的非脱垂子宫TVH手术时间、术中出血量及术后盆腔感染率分别为(73±25)min、(237±86)ml、1.69%(7/413);子宫体积≤16孕周患者的非脱垂子宫TVH手术时间、术中出血量及术后盆腔感染率分别为(42±16)min、(101±58)ml、0.78%(13/1673),不同体积子宫上述各项指标比较,差异有统计学意义(P<0.01)。(2)既往有无盆腹腔手术史比较:既往有无盆腹腔手术史患者的非脱垂子宫TVH手术时间和术中出血量比较,差异无统计学意义(P>0.05),但有盆腹腔手术史患者非脱垂子宫TVH的术中并发症发生率升高;(3)有无阴道分娩史患者非脱垂子宫TVH的手术时间和术中出血量比较,差异也无统计学意义(P>0.05);119例合并卵巢囊肿患者均成功行非脱垂子宫TVH。结论子宫体积≤16孕周患者的非脱垂子宫TVH是安全、可行的,子宫体积>16孕周患者的非脱垂子宫TVH手术难度较大,是否行TVH,需根据术者的经验及患者的情况进行选择;既往有盆腹腔手术史,可增加非脱垂子宫TVH并发症的发生率;对于子宫体积≤16孕周的患者,有无阴道分娩史均不影响TVH的成功率;TVH同时处理直径≤6cm的卵巢单纯性囊肿是可行的。

Indications and contraindications of vaginal hysterectomy for non-prolapsed uterus

OBJECTIVE: To study the indications and contraindications of vaginal hysterectomy for non-prolapsed uterus. METHODS: Totally 2086 patients underwent vaginal hysterectomy during the period of June 1992-June 2003 were analysed and the surgery quality and incidence of complications among patients with different sizes of uteri, with or without history of pelvic or abdominal surgery, with history of vaginal delivery and adnexectomy were compared. RESULTS: (1) The patients with uteri > 16 weeks of gestation were associated with longer operating time (73 +/- 25) vs (42 +/- 16) min)], more blood loss (237 +/- 86) vs (101 +/- 58) ml] and higher rate of pelvic infection (1.69% vs 0.78%) when compared to the patients with uteri < or = 16 weeks. The differences were statistically significant (P < 0.01). (2) There was no significant difference in the operating time and intraoperative blood loss between the patients with and without history of pelvic or abdominal surgery (P > 0.05), however, the surgery group had higher side injury rate during operation. In addition, 119 patients complicated with ovarian cyst underwent vaginal ovarian cystectomy successfully. CONCLUSION: Vaginal hysterectomy for patients with uteri < or = 16 weeks of gestation is safe and feasible. The procedure is relatively difficult for uteri > 16 weeks and should be determined according to the operator's experience and the patient's condition. A history of pelvic or abdominal operation increases the side injury rate in vaginal hysterectomy. The successful rate of vaginal hysterectomy in patients with uteri < or = 16 weeks of gestation is not affected by the history of vaginal delivery. During vaginal hysterectomy, ovarian cystectomy is feasible for the ovarian cyst < or = 6 cm. Skillful operator and use of appropriate instrument expand the indication of vaginal hysterectomy.