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非脱垂子宫切除四种术式的临床研究
作者姓名:Hua K  Lin J  Liu X  Feng W  Jiang H  Fang F  Hu C  Zhang J  Xu C
作者单位:200011,上海,复旦大学附属妇产科医院
摘    要:目的 探讨非脱垂子宫切除微创手术在妇科的临床应用价值。方法 对608例因不同原因需行子宫切除的患者分别行经阴道全子宫切除术(TVH),腹腔镜辅助下阴道全子宫切除术(LAVH),腹腔镜鞘内宫颈上子宫切除术(CISH),经腹全子宫切除术(TAH),对不同术式的适应证,禁忌证,并发症,手术优越性进行分析比较。结果 TVH及LAVH术式受子宫大小,膀胱反折腹膜粘连,阴道狭窄等条件的限制;对于盆腹腔严重粘连,需切除粘连的附件工5cm以上附件囊肿者,以LAVH及CISH术式为宜;子宫大于16孕周时,宜选择CISH或TAH术式,腹腔镜鞘内宫颈上子宫切除术可保持阴道及宫旁正常解剖结构的完整性,而且切除了好发宫颈癌的宫颈移行带部位;在临床高度怀疑子宫或子宫内膜恶性病变时,应选用LAVH或TAH术式,子宫切除微创手术具有不增加术中出血量和手术时间,术后病率低,使用镇痛剂少,住院时间短等优越性。结论 微创子宫切除术具有效优,低创的特点,具有临床推广前景。

关 键 词:非脱垂子宫切除  临床研究  经阴道式  腹腔镜  手术方式  微创外科
修稿时间:2002年5月23日

Four surgical patterns of hysterectomy for uterine without prolapsis: a clinical study
Hua K,Lin J,Liu X,Feng W,Jiang H,Fang F,Hu C,Zhang J,Xu C.Four surgical patterns of hysterectomy for uterine without prolapsis: a clinical study[J].National Medical Journal of China,2002,82(23):1599-1603.
Authors:Hua Keqin  Lin Jinfang  Liu Xishi  Feng Weiwei  Jiang Hua  Fang Fang  Hu Changdong  Zhang Jianfeng  Xu Chang'en
Institution:Gynecological and Obstetrical Hospital, Fadan University, Shanghai 200011, China.
Abstract:OBJECTIVE: To evaluate the clinical effects of the four surgical patterns of hysterectomy for uterine without prolapsis. METHODS: Six hundred and eight patients with different gynecological diseases were operated upon by transvaginal hysterectomy (TVH, 78 cases), laparoscopically assisted vaginal hysterectomy (LAVH, 102 cases), classical intrafascial supracervical hysterectomy (CISH, 228 cases), or transabdominal hysterectomy (TAH, 200 cases). The clinical effects of these surgical patterns were analyzed. RESULTS: The success rate was 100% for TVH, 99.1% for CISH, and 98.0% for LAVH. The bleeding time and bleeding amount were significantly shorter or less in the TVH group than in the other 3 groups (P < 0.05), without a significant difference among the 3 groups. The percentage of analgesic use and postoperative morbidity were significantly higher in the TAH group than in the other 3 groups (P < 0.01), without a significant difference among the 3 groups. The days of hospitalization in the TAH group were significantly more than those in the other 3 groups (P < 0.05), without a significant difference among the 3 groups. The hospitalization expense was greater in the LAVH and CISH groups than in the TVH and TAH groups Except 2 cases of damages to the supravesical artery or ureter occurring during the early stage of CISH group, no surgical damage was found. CONCLUSION: Highly effective and with less injury, minimally invasive surgery in hysterectomy is worth spreading. LAVH and CISH apply in the cases with severe pelvic adhesion, with adhesive adnexa to be resected, or with adnexal cyst > 5 cm. CISH and TAH apply in the uterine larger than 16 weeks pregnant size. LAVH and TAH apply in the cases highly suspected as malignant diseases of uterine or endometrium.
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