经腹、经阴道及腹腔镜辅助经阴道全子宫切除术临床比较

目的比较经腹全子宫切除术（transabdominal hysterectomy,TAH）、非脱垂子宫经阴道全子宫切除术（non-prolapsed transvaginal hysterectomy,TVH）及腹腔镜辅助经阴道全子宫切除术（laparoscopical-ly assisted vaginal hysterectomy,LAVH）的临床特点及应用价值。方法回顾性分析我院因子宫良性疾病行全子宫切除术的365例患者临床资料,按手术方式分为：TAH组（138例）、TVH组（110例）及LAVH组（117例）。比较三组手术时间、术中出血量、术后镇痛率、肛门排气时间、术后病率、术后住院时间以及医疗费用。结果三组术中出血量、术后病率比较无统计学差异（P〉0.05）,TVH组及LAVH组术后镇痛率、术后肛门排气时间及住院时间均少于TAH组（P〈0.05） TAH组及TVH组的手术时间和医疗费用明显低于LAVH组（P〈0.05）。结论TVH术式手术时间短、术后镇痛率低、住院时间短、医疗费用低,兼有TAH及LAVH的优点 临床应根据不同情况选择不同的子宫切除术式以达到最佳治疗效果。

Clinical Comparison of Three Procedures of Hysterectomy:Transabdominal Hysterectomy,Non-prolapsed Transvaginal Hysterectomy,and Laparoscopically Assisted Vaginal Hysterectomy

Objective To compare the characteristics and values among transabdominal hysterectomy （TAH）, non-prolapsed transvaginal hysterectomy （TVH）, and laparoscopieally assisted vaginal hysterectomy （LAVH）. Methods A total of 365 patients with benign uterine diseases underwent hysterectomy were re- viewed. They were divided into TAH group, TVH group, and LAVH group according to surgical procedures, with 138, l10 and 117 cases respectively. The operative duration, intraoperative blood loss, postoperative anal- gesia administration, postoperative gastrointestinal function recovery time, postoperative morbidity, postopera- tive hospital stay and medical cost were compared among the three groups. Results There were no statistic differences in intraoperative hlood loss and postoperative morbidity among the three groups （P 〉 0.05）. The postoperative analgesia administration rate, gastrointestinal function recovery time and hospital stay of TVH group and LAVH group were all significantly lower than those of TAH group （P 〈 0.05 ）. The operative dura- tion and medical cost of LAVH were obviously higher than those of TAH group and TVH group （ P 〉 0.05 ）. Conclusions TVH procedure own the advantages of both TAH and LAVH with shorter operating time and post- operative hospital stay, lower postoperative analgesia rate, less medical expenses. The suitable procedure of hysterectomy could be selected based on the practical conditions of patients.