开腹与微创子宫全切除术临床结局分析

目的分析开腹、腹腔镜下及阴式全子宫切除术后的临床结局，探讨其手术适应证。方法回顾性分析我院2007年1月-2009年8月同期行开腹子宫全切术患者60例（开腹组）、腹腔镜下子宫全切术患者62例（腹腔镜A组32例和腹腔镜B组30例）及阴式子宫全切术患者65例（阴式组）的临床资料。结果阴式组与腹腔镜A组比较：阴式组住院费用明显少于腹腔镜A组，排气时间及手术时间明显短于腹腔镜A组，差异均有统计学意义（P〈0．05或P〈0．01）；腹腔镜B组与开腹组比较：腹腔镜B组手术时间明显长于开腹组，术后住院时间明显短于开腹组，差异均有统计学意义（P〈0．05）。结论腹腔镜下及阴式子宫全切术均为微创术式，2种术式均安全有效；阴式手术住院费用更少，对腹腔干扰更小，胃肠道反应及术后疼痛更轻，而子宫增大超过14周孕、盆腔粘连严重者，应选择开腹手术。

The analysis for clinical outcomes of abdominal hysterectomy and minimally invasive hysterectomy

Objective To analyse the clinical outcomes of abdominal,laparoscopic and vaginal hysterectomy,and explore its surgical indication. Methods Used the retrospective method to analyse the clinical data of 60 cases in abdominal hysterectomy eabdominal group,62 eases in laparoseopic hysterectomy（ laparoscopic group A of 32cases and laparoscopic group B of 30 cases ） and 65 cases in vaginal hysterectomy（ vaginal group）in our hospital over the same period from January in 2007 to August in 2009. Results The vaginal group and the laparoscopic group A：The hospitalization costs of the vaginal group was significantly less than the costs of the laparoscopie group A ; Anal exhaust time of vaginal group was significantly shorter than the laparoscopic group A, and the differences were statistically different（ P 〈 0. 05 or P 〈 0. 01 ）. Compared with the laparoseopic group B and the laparotomy group, the results were that postoperative time of laparoseopie group B was significantly shorter than the laparotomy group ; The laparoscopic group B of the incident rate and analgesic use rate was less than laparotomy group ; The operative time of the laparoscopic B is longer than the laparotomy group, the differences were statistically different （ P 0.05 ）. Conclusion Laparoscopic and vaginal hysterectomy both are minimally invasive surgical, and they are safe and effective;The hospitalization costs of the vaginal surgery are less, abdominal disturbance is smaller, gastrointestinal and postoperative pain are lighter. While the increasing of uterus is more than 14 gestation, the severe easespelvic of adhesions should select laparotomy.