改良大子宫腹腔镜辅助阴式切除术的临床研究

目的比较大子宫阴式切除术（TVH）与改良腹腔镜辅助下大子宫阴式切除术（LAVH）的临床效果。方法收集该院2003年1月～2006年1月接受以上不同途径大子宫切除术患者（208例）的临床资料，其中阴式大子宫全切除术86例（阴式组），改良腹腔镜辅助大子宫阴式全切除术122例（腹腔镜组），比较两组的手术时间、术中出血量、体温恢复时间、术中并发症及远期并发症。结果LAVH组与TvH组相比，手术时间明显缩短（P〈0．01），出血量明显减少（P〈0．001），体温恢复时间两组相比差异无显著性（P〉0．05）。TVH组术中发生膀胱损伤2例，转开腹行膀胱修补，术后发生阴道残端脓肿1例；LAVH组全部在镜下完成。无中转开腹。近期随访。TVH组发生阴道前壁脱垂2例，阴道后壁轻度脱垂1例；LAVH组无严重并发症发生。结论大子宫行改良LAVH手术优于TVH。

Clinical study of big uterus reforming laparoscopically assisted vaginal hysterectomy

Objective To compare clinical result of through vaginal hysterectomy (TVH) and modified laparoscope assisted vaginal hysterectomy (LAVH) for big uterus. Method 208 cases of big uterus hysterectomy through vaginal or assisted vaginal hysterectomy from Jan 2003 to Jan 2006 were collected in our hospital. There were 86 through vaginal hysterectomies (TVH groups) and 122 reforming laparoscope assisted vaginal hysterectomies (LAVH groups). operation time,bleeding volume,body temperature recovery time,pro-operation and post-operation complications were studied and compared between two groups. Result In modified laparoscope assisted vaginal hysterectomy group,operation time was shorted and bleeding volume in operation decreased obviously compared with TVH groups (P<0.01). But body temperature recovery time was not statistically defferent (P >0.05) between both groups. There were 2 cases of bladder injury and 1 vaginal stump abscess in TVH groups,and impaired bladder was mended through cutting-abdomen operation. 22 modified laparoscope assisted vaginal hysterectomies were all finished through short-time visit,and there were 2 vaginal anterior prolapses and 1 little vaginal posterior prolapses In TVH. There was no serious complications in LAVH. Conclusion For big uterus,reforming laparoscopically assisted vaginal hysterectomy (LAVH) is better than through vaginal hysterectomy (TVH).