阴式子宫次全切除术的临床应用

目的 探讨非脱垂、良性病变的子宫实施保留宫颈的阴式子宫次全切除术的可行性和安全性.方法 对要求保留宫颈的86例非脱垂、良性子宫病变患者实施阴式子宫次全切除术,并选择同期90例经腹次全子宫切除术患者作为对照,比较两组患者平均手术时间、术中出血量、术后肛门排气恢复时间、术后病率、术后住院时间.结果 86例阴式子宫次全切除术患者中除2例借助腹腔镜分离盆腔粘连后完成阴式手术外,其余均获成功.两组比较,平均手术时间、术中出血量及术后住院时间的差异均无统计学意义（均P〉0.05）,而肛门排气时间明显缩短（P〈0.01）,术后病率亦明显下降（P〈0.05）.结论 对非脱垂子宫、良性病变子宫（小于孕12周）者,严格掌握适应证实施阴式子宫次全切除术是相对安全、可行的,借助腹腔镜可扩大手术适应证.

Transvaginal subtotal hysterectomy for non-prolapsed uterus and benign lesions of the uterine cervix

Objective To evaluate the efficacy and safety of transvaginal subtotal hysterectomy in non-prolapsed uterus and benign lesions of the uterine cervix. Methods Transvaginal subtotal hysterectomy was performed for 86 cases of non-prolapsed uterus and benign lesions of the uterine cervix from May 2007 to February 2009; and 90 cases of abdominal subtotal hysterectomy performed during same period served as controls. The average operation time, bleeding volume, anal exhaust time, postoperative morbidity, length of hospital stay of two groups were compared. Results The transvaginal subtotal hysterectomy was successfully performed in all patients except 2 cases, in which the pelvic adhesions was separated with laparoscopic surgery. Compared with control group the anal exhaust time was reduces and postoperative morbidity was decreased in transvaginal group （P〈 0.01）; and there were no significant differences in mean operation time, bleeding volume and length of postoperative hospital stay between two groups （P〉0.05）. Conclusion Transvaginal subtotal hysterectomy is safe and feasible for non-prolapsed uterus and benign lesions of uterine cervix; supplemented laparoscopic surgery can expand the indications.