新式非脱垂子宫经阴道切除术

非脱垂子宫经阴道切除术 (ｔｒａｎｓｖａｇｉｎａｌｈｙｓｔｅｒｅｃｔｏｍｙ,ＴＶＨ)具有损伤小、恢复快、住院时间短、术后无切口疼痛、无腹壁瘢痕等诸多优点。目前 ,国内大多数医院仍未普遍开展ＴＶＨ。主要原因是该术式术野小、暴露困难 ,副损伤并发症发生率较高。本研究特制了阴式子宫切除专用器械 ,并对手术的关键步骤进行了较大改进 (即新式ＴＶＨ) ,使该手术变得简单易行 ,扩大了手术的适应证 ,手术质量明显提高。现报道如下。一、新式ＴＶＨ的方法1 环切宫颈、分离膀胱宫颈间隙和子宫直肠间隙 :方法与苏应宽[1] 介绍的方法相似。…     

非脱垂子宫经阴道切除术130例临床分析

目的:探讨非脱垂子宫经阴道切除术(TVH)临床应用情况。方法:选择自2006年6月至2011年6月非脱垂子宫TVH130例(TVH组),与同期开展的经腹子宫切除术140例(TAH组)的临床应用情况行回顾性对比分析。结果:TVH组手术时间、术后下床活动时间、肛门排气时间、住院时间均明显短于TAH组(均P<0.05),TVH组患者术后疼痛明显轻于TAH组。TVH组共发生并发症11例(8.46%),TAH组共发生并发症10例(7.14%),两组比较差异无统计学意义(P>0.05)。TVH组术后发生出血与脏器损伤5例(3.84%),明显高于TAH组(1例术后出血,0.71%),两组差异有统计学意义(P<0.05)。结论:TVH具有疼痛轻、恢复快、住院时间短等优点。TVH、TAH两组并发症总发生率无明显差别,但TVH发生脏器损伤及术后出血的概率较TAH高,其与患者的选择及术者的经验有关,应高度重视,认真防范。     

非脱垂子宫经阴道切除术的临床应用

目的对新式非脱垂子宫经阴道切除术开展临床研究。方法对良性病变的非脱垂子宫切除的患者,分为新式TVH与腹式两组进行临床观察。结果新式TVH组平均手术时间、肛门排气时间≤48小时、术后病率、术后疼痛、住院时间分别为70.32±17分钟、93.7%、15.6%、75%、5.2±1.19天,腹式组分别为102.67±17分钟、54.8%、64.5%、6.4%、8.2±1.00天,新式TVH组与腹式组比较差异有非常显著性(P均<0.01)。两组平均出血量分别为132.1±34.2ml、120±33.4ml,新式TVH组较腹式组稍多,但差异无显著性(P>0.05)。结论新式TVH组子宫切除较腹式子宫切除手术时间短,腹腔干扰少,术后胃肠功能恢复早,疼痛轻,术后病率低,住院日短,腹壁不留切口疤痕,深受患者青睐。只要掌握好手术适应证,非脱垂子宫经阴道切除可充分展示出其诸多优越性。     

新式非脱垂子宫经阴道切除术

非脱垂子宫经阴道切除术由Langenbeck 1813年首次施行，至今已有近200年历史，由于人们认为操作困难、并发症较多而未能得到广泛的应用。但近10年来，随着微创技术的开展，这一术式又逐步受到了国内外妇产科医师的重视，据文献报道欧美国家非脱垂子宫经阴道切除术已占全子宫切除术的61％-90％。笔者2000年开始将新式非脱垂子宫经阴道切除术这一简单易行的手术应用于临床，     

非脱垂子宫经阴道手术并发症处理体会

经阴道手术对盆腔脏器干扰少，术后患者疼痛轻，康复快，但经阴道手术的并发症需重视。2001年1月至2006年1月我院为678例非脱垂子宫行经阴道手术，现将发生的并发症及处理体会，报告如下。     

改良式非脱垂子宫经阴道切除术52例临床分析

近年来，随着微创观念的深入和经阴道系列手术器械的改进和手术技巧的提高，阴式子宫切除术（TVH）的适应证日益扩大，2005年8月至2008年12月，北京市昌平区医院对52例非脱垂良性子宫病变患者实施了改良式经阴道子宫切除术，取得满意效果，现将结果报道如下。     

644例非脱垂大子宫经阴道切除临床总结分析

目的 :探讨非脱垂大子宫经阴道切除的可行性与安全性。方法 :对 6 4 4例子宫超过 10周孕大小的患者施行经阴道子宫切除术。患者平均年龄 4 2 5岁 ,包括子宫肌瘤 4 74例 ,子宫腺肌病 170例。术前检查子宫 10～ 12周孕大小者 172例 ,>12～ 14周孕者 2 0 1例 ,>14～ 16周孕者 175例 ,超过 16周孕者 96例。结果 :6 4 4例中除 1例因术中发现肌瘤肉瘤样变而改开腹手术外 ,余 6 4 3例均成功行阴式子宫切除术 ,成功率达 99 8%。子宫平均重 370 7g(16 5～ 10 80g) ,平均手术时间 6 0 2分钟 (32～ 98分钟 ) ,术中平均出血量 15 0 4ml(5 0～ 30 5ml) ,术后肠道功能恢复时间平均 1 5天 (2～ 3天 ) ,留置尿管 2 4小时 ,阴道流液时间平均为 1 6天 ,体温恢复正常时间平均 3 6天 (1～ 5天 ) ,术后住院时间平均为 4 8天 (4～ 7天 )。结论 :适当的病例选择加上灵活的手术技巧 ,非脱垂大子宫经阴道切除是安全可行的。     

新式非脱垂子宫经阴道切除36例临床分析

微创外科迅速发展的今天，在子宫切除术方面，如何选择安全性高、创伤小、恢复快的手术方式是医患共同关心的问题。传统的经腹子宫切除术(TAH)比例逐渐降低，腹腔镜子宫切除术(CISH)在技术方面要求太高、费用贵，新式非脱垂子宫经阴道切除术(新式TVH)具有安全、可靠、创伤小、恢复快和腹部不留瘢痕等优点，我们两院从2001年7月～2004年4月成功实行新式TVH36例，现报告如下。     

改进的非脱垂子宫经阴道切除术

经阴子宫切除术的优点已为妇科学者所共识。但因术野受限及解剖不够熟练使手术开展远较经腹为低。随着微创化手术的开展,经阴子宫切除更优于经腹小切口及腹腔镜子宫切除(设备、技术受限),故经阴子宫切除术倍受患者欢迎,使目前国内、外经阴子宫切除术渐渐增多,比例增加。为使不能经阴之大子宫(肌瘤)病变可经阴切除,当今,国内外妇科学者术前采用RU486、R2323、GnRHa等缩小肌瘤与宫体,但后两者费用较高,且有一定副作用。本期刊出“改进的的非子宫脱垂经阴子宫切除术”值得同道们探究试用。一是手术步骤有重要改进,二是用此术式可切除12～16孕周的大子宫。但读者读后可能会提出一些疑问:(1)因不缝扎骶主韧带是否会发生近期术后出血;(2)远期是否会影响盆底的支托功能?另外,评价任何一种手术均应看疗效,而疗效都必须考虑如下因素:病人的选择、术前诊断的准确性、医生的技术、术中术后并发症、术后随访时间的长短及治愈标准等。作为本术式,不能仅看手术时间,而重要的是在手术安全、少并发症及最终疗效佳。那么,此术式术中处理骶、主韧带不缝扎近期能否出血?笔者近期特意到作者医院进行了手术观摩。手术过程中所见是上推至子宫动脉主干及主干分出的上行支不出血,直视下缝扎、切断后缝扎子宫动脉(与静脉)及术毕缝     

Nondescent vaginal hysterectomy: a constantly improving surgical art

Objective

This study was undertaken to check the feasibility of the vaginal route as the primary route for all hysterectomies, in the absence of uterine prolapse, for benign conditions.

Methods

During 2005 to 2007 an effort was made to perform as many hysterectomies vaginally with or without oophorectomy in women with benign or premalignant conditions in the absence of prolapse. Severe endometriosis, immobility of the uterus, uterine size more than 18 weeks and malignancy were excluded. Patients were classified into two groups — Group I — uterine size up to 12 weeks, with no risk factors and Group II — uterine size 12–18 weeks or with confounding factors like, mild to moderate endometriosis, nulliparity or LSCS in the past. The outcome was compared between the two groups and abdominal hysterectomies done for benign conditions. Statistical analysis was done by SE(d) between mean and proportion.

Results

A total of 164 cases nondescent vaginal hysterectomies were done. Of these, 92 (56.1%) were in group I and 72 (43.9%) in group II. The operation time in Group II was significantly more than in group I (81.3 minutes with SD of 31.4 s. 62.6 minutes SE(d) between 2 means-7.49). Debulking techniques were required in 58.7% of the cases in group II compared to 2.1% in group I. Both the groups had one conversion each. The peroperative blood loss, pain score, hospital stay and return to normal activity, was comparable in both the groups of vaginal hysterectomy (VH) and significantly superior to those undergoing abdominal hysterectomies for benign conditions.

Conclusion

The vaginal approach is possible in most benign conditions requiring hysterectomy and is superior to the abdominal route with respect to recovery and complication rates.     

A comparison of abdominal and vaginal hysterectomy for the large uterus.

OBJECTIVE: To compare the perioperative outcomes of women with an enlarged uterus (>or=250 g) who had abdominal and vaginal hysterectomies. METHOD: Retrospective study of the perioperative outcomes of 288 consecutive women with an enlarged uterus, of whom 200 underwent an abdominal hysterectomy and 88 a vaginal hysterectomy, all for benign gynecological conditions. RESULTS: Among the perioperative complications, only the risk of ileus was significantly higher in the group that underwent abdominal hysterectomy. Although the need for blood transfusions was similar between the groups, mean perioperative hemoglobin change was significantly lower for women who had the abdominal approach. Vaginal hysterectomy shortened the length of hospitalization significantly but did not affect the operative time. All of these differences remained significant after adjusting for uterine weight (P<0.05). Baseline characteristics were similar between the groups, except for uterine weight. CONCLUSIONS: For women with a uterus weighing 250 g or more, vaginal hysterectomy shortens the hospital stay without significantly increasing perioperative morbidity when compared with the abdominal route.     

非脱垂子宫阴式切除术临床应用价值

目的 探讨非脱垂子宫阴式切除术的临床价值.方法 2005年9月至2007年9月在中国医科大学附属盛京医院,将阴式子宫切除术(TVH)420例作为观察组,经腹子宫切除术(TAH)100例作为对照组1,观察手术时间、出血量及术后情况.结果 TVH组手术成功率为99.52%,膀胱、直肠副损伤发生率为0.002%.TVH组与TAH组比较,手术时间分别为(59.73±18.70)min,(61.21±15.97)min;出血量分别为(82.31±25.33)mL,(76.54±27.33)mL,P>0.05.术后病率、肠功能恢复时间、术后平均住院日,TVH组分别为5.5%、(31.87±5.56)h、(3.89±1.68)d;TAH组分别为19.0%、(55.45±8.97)h、(5.66±2.12)d,P均<0.05;术后阴道炎性息肉发生率,TVH组(9.33%)高于TAH组(5.00%),P<0.05.TVH组以无影响因素病例为对照组2,手术时间为(50.70±16.37)min,出血量为(71.33±25.00)mL;有影响因素各组手术时间和出血量分别为:子宫≥妊娠12周组为(66.86±18.17)min及(79.75±37.81)mL;最大肌瘤直径≥9cm组为(86.00±12.31)min及(98.00±16.73)mL;盆腔粘连组为(62.08±11.60)min及(90.00±25.02)mL;P均<0.05.而剖宫产术后组为(54.09±13.70)min及(70.68±18.64)mL;合并附件肿物组为(51.29±14.92)min及(73.23±14.69)mL;P均>0.05.结论 非脱垂子宫行阴式切除术创伤小,手术安全可靠.     

Surgical outcomes of hysterectomy by transvaginal natural orifice transluminal endoscopic surgery (vNOTES) compared with laparoscopic total hysterectomy (LTH) in women with non-prolapsed and benign uterine diseases

ObjectiveWe aimed to compare the surgical outcomes between hysterectomy by transvaginal natural orifice transluminal endoscopic surgery (vNOTES) and laparoscopic total hysterectomy (LTH).Materials and methodsThis study is a retrospective chart analysis. From January 1, 2015, to December 31, 2017, a total of 183 patients of reproductive age with an indication for hysterectomy due to non-prolapsed and benign uterine diseases were enrolled. After exclusion, 20 patients were included in the vNOTES group, and 66 patients were included in the LTH group. Various post-operative surgical outcomes such as operative time, blood loss, uterus weight, a decrease in hemoglobin level on post-operative day one, post-operative pain scale, complications, length of hospitalization, and re-admission rate were measured.ResultsNo difference was observed between both groups regarding operative time, blood loss, uterine weight, a decrease in hemoglobin level on post-operative day one, complications, hospital stay, and re-admission rate. Patients in the vNOTES group had significantly less post-operative pain compared with those in the LTH group (p = 0.03).ConclusionsThe surgical outcomes of hysterectomy by vNOTES could be similar to those of LTH. Patients undergoing hysterectomy by vNOTES may have less post-operative pain compared with those undergoing LTH. However, the sample size was small, and the results need more evidence to confirm these findings.     

大子宫经阴道切除25例临床分析

目的 探讨大子中经阴道切除的安全性和可行性。方法 采用子宫劈开、肌核剜除、碎解等缩小子宫体积的方法,对２５例子宫增大如１２～１７孕周「平均（１４．０±１．７）周」、重２８０～５７０ｇ「平均（３７２±７４）ｇ」的子宫肌瘤患,行经阴道子宫切除术（ＴＶＨ）。对手术方式、时间、出血量、副损伤及术后病率进行分析。结果 ２２例成功经阴道切除,３例改经腹手术。手术成功率８８％。术中膀胱损伤１例,大出血１例,输     

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。     

不同子宫切除术式的临床疗效分析

目的探讨腹腔镜下不同子宫切除术的临床疗效。方法回顾性分析2000～2004年78例患者分别行腹腔镜下子宫次全切除术（LSH）、改良筋膜内子宫全切术（MCISH）或腹腔镜辅助的阴式子宫切除术（LAVH），比较三组患者术中、术后情况。结果三组患者的手术时间、术后疼痛发生率、术后使用抗生素时间、体温升高、肛门排气时间、术后下床活动时间和术后住院时间差异均无显著性，手术时间、术中出血量LAVH组较LSH、MCISH组显著增加，LAVH、MCISH组术后性生活恢复时间均较LSH组延长。三组均无手术并发症发生。结论腹腔镜子宫全切术具有创伤小，腹腔内环境干扰小，恢复快等优点。腹腔镜下子宫次全切除术、筋膜内子宫切除术和腹腔镜辅助阴式子宫切除术都是安全可行的，三种手术方式各有其优缺点，术式选择应根据设备的情况、患者情况及术者对手术方式的掌握程度来定。