三种途径子宫切除术治疗良性子宫疾病的比较

目的：比较阴式子宫切除（ vaginal hysterectomy ，VH）、腹腔镜辅助阴式子宫切除（ laparoscopically assisted vaginal hysterectomy，LAVH）以及腹腔镜子宫切除（total laparoscopic hysterectomy ，TLH）治疗子宫良性疾病的特点。方法回顾性分析我院2011年3月～2013年11月因子宫良性病变行全子宫切除155例资料，由患者选择手术方式，VH组60例，LAVH组50例，TLH组45例。比较3组手术时间、出血量、止痛药的使用以及住院时间的差异。结果手术时间VH组中位数65（40～85） min]＜LAVH组90（45～150） min]＜TLH组120（80～180） min]（χ2＝89．105， P＝0．000）；术中出血量VH组208（155～241） ml]和TLH组183（159～220） ml]＜LAVH组359（316～413） ml]（χ2＝72．609， P＝0．000）；术后应用止痛药LAVH组2（1～5）支]＜VH组4（1～8）支]和TLH组5（3～8）支]（χ2＝59．243， P＝0．000）。术后住院时间3组间差异无显著性（P＞0．05）。结论对于子宫良性病变，VH及LAVH是比较好的子宫切除术式。

Comparison of Three Different Approaches in Hysterectomy for Benign Uterine Diseases

Objective To compare the characteristics of vaginal hysterectomy （ VH ） , laparoscopically assisted vaginal hysterectomy （ LAVH ） and total laparoscopic hysterectomy （ TLH ） for benign uterine diseases . Methods We retrospectively collected 155 cases of hysterectomy for benign uterine diseases in our hospital during March 2011 to November 2013.The surgical approach was chosen by patients .There were 60 cases of VH, 50 cases of LAVH, and 45 cases of TLH.The operating time, blood loss, consumption of analgesics , and the length of hospital stay were compared among the three groups . Results The median operation time was 65 min （range, 40-85 min） in the VH group, 90 min （range, 45-150 min） in the LAVH group, and 120 min （range, 80-180 min） in the TLH group, with statistically significant difference （χ2 =89.105, P=0.000）.The blood loss had no significant difference between the VH group （208 ml, 155-241 ml） and the TLH group （183 ml, 159-220 ml）, but significantly less than that in the LAVH group 359 ml （316-413 ml）,χ2 =72.609, P=0.000].The consumption of analgesics in the LAVH group （2 doses, 1-5 doses） was significantly less than that in the VH group （4 doses, 1-8 doses） and the TLH group （5 doses, 3-8 doses） （χ2 =59.243, P=0.000）.There was no significant difference in postoperative hospital stay among the three groups . Conclusion For benign uterine disease , VH and LAVH are preferential surgical procedures .