经阴道子宫切除术1 990例并发症临床分析

目的 分析经阴道子宫切除术并发症的发生率、发生原因及处理方法 ,探讨其防治措施.方法 对2000年1月～2006年6月1 990例行经阴道子宫切除术患者的手术并发症临床资料作回顾性分析.结果 1 990例经阴道子宫切除术患者中75例出现并发症,发生率为3.77%.其中膀胱损伤21例(1.06%),输尿管损伤5例(0.25%),直肠损伤6例(0.30%);术后发生残端感染30例(1.51%),残端血肿8例(0.40%),腹腔内大出血2例(0.10%),阴道狭窄2例(0.10%),肠梗阻1例(0.05%).所有并发症均经手术或保守治疗得到纠正,未遗留后遗症.术中脏器损伤多发生于伴有盆腔粘连或子宫大而活动欠佳的患者,如有盆腔手术史、子宫内膜异位症、子宫下段大肌瘤等.结论 经阴道子宫切除术较易损伤邻近器官从而发生相应并发症,术者需熟悉盆腔解剖结构,熟练掌握经阴道子宫切除术技巧,同时需严格把握手术适应证.

Clinical study on the complications of transvaginal hysterectomy: analysis for 1990 cases

Objective To analyze incidence,pathogenesis and treatment of the complications of transvaginal hysterectomy(TVH)collected during past six years,and to discuss the possible methods of prevention.Methods The patients involved in present study were admitted and underwent the transvaginal hysterectomy in the General Hospital of PLA from Jan.2000 to Jun.2006.The data of complications occurred at intra-or post-operation were retrospectively analyzed.Results Among all of the 1990 cases with TVH,complications occurred in 75 cases,the incidence of complication was 3.77%,including 21 cases of bladder injury(1.06%),5 cases of ureter trauma(0.25%),6 cases of rectal injury(0.3%),30 cases of vaginal stump inflammation(1.51%),8 cases of vaginal stump haematoma(0.4%),2 cases of intra-abdominal hemorrhage(0.1%),2 cases of vaginal narrowness(0.1%)and 1 case of intestinal obstruction(0.05%).The bladder injury and vaginal stump inflammation almost toke the two third of total cases.Some complications were got correction by surgery appropriately during or after the operation when injuries were found.Some cases were managed by conservative treatment.All of the patients with complications were healed without any sequelae.The organ injuries occurred more easily in the cases with pelvic adhesion or less movable large uteri,such as the cases with the history of pelvic operation,the endometriosis or the lower segment myoma.Conclusions The organs adjoined to uterus were easily damaged by TVH during the performance of operation,and the corresponding complications are common after the operations.The operator should familiar with the pelvic anatomy,master the skilled surgical techniques and suitably control the indications of the TVH.With the improvement of techniques in TVH and the research of new instrument applied in this procedure,the incidence of complications in TVH would be further reduced.