不同途径非脱垂子宫全切术对女性生活质量的影响

目的 探讨不同途径非脱垂子宫全切术对女性生活质量的影响。方法 对2004年1月～2009年6月在我院就诊的1060例患子宫良性病变的非脱垂子宫患者按手术方式的不同随机分经腹(TAH)组、经阴道(TVH)组和腹腔镜辅助(LAVH)组，入院时及术后6个月、1年分别进行焦虑症状、生活质量、性生活质量、发生阴道顶端脱垂及压力性尿失禁情况调查。结果 入院时三组患者的焦虑和抑郁症状、生活质量、性生活质量均无显著性差异（P>0.05）。术后6个月，TVH组和LAVH组焦虑症状比TAH组显著减轻（P<0.05或P<0.01）；TVH组在情感、精力方面，LAVH组还在社会活动、身体活动等方面与TAH组在统计学上有显著或极显著性差异（P<0.05或P<0.01）；LAVH组在情感、精力和身体活动方面与TVH组在统计学上有显著或极显著性差异（P<0.05或P<0.01）；TVH组和LAVH组患者的性生活满意度高于TAH组(P<0.01)。术后1年发生阴道顶端脱垂和压力性尿失禁的情况，三组在统计学上无显著性差异（P＞0.05)。结论 TVH和LAVH对患者生活质量的影响优于TAH，TVH和LAVH为较为理想的术式。

Different ways of total hysterectomy for women with Non-prolapsed uterus affect quality of their life

Objective: To investigate what consequence of different ways of total hysterectomy for women with Non-prolapsed uterus impling for women life quality. Methods: 1060 patients with Non-prolapsed uterus having benign lesion and operation indication were randomily divided into TAH group, TVH group and LAVH group. We respectively investigated condition of anxiety, quality of life and sexual life, stress incontinence as well as the top vagina prolapse on admission，afteroperation 6 months and 1 year. Results:There were no significant difference in anxiety and depression symptoms, quality of life and sexual life in three groups (P＞0.05).However, afteroperation 6 months, the anxiety of group TVH and LAVH was less than that of TAH group (P<0.05 or P<0.01),meanwhile, LAVH group’s symptom was the best of all. Compare to TAH group, group of TVP and LAVH had significantly difference in emotion and vigor, and LAVH group had significantly difference in Social activities and physical activities (P＜0.05 or P＜0.01).There were significant difference between LAVH group and TVH group in emotion, vigor and physical activities(P＜0.05 or P＜0.01).There also had significant difference in degree of satisfaction of sexual life except the pain in intercourse between TVH group and LAVH group(P＜0.01).Afteroperation 1 year, there were no significant difference in stress incontinence and the top vagina prolapse in there groups(P＞0.05). Conclusions: The condition of anxiety, life quality and sexual life quality in group TVH and LAVH was better than that TAH group, but there were no significant difference in pelvic floor dysfunction. All in all, TVH and LAVH are ideal surgery for women with Non-prolapsed uterus having benign lesion and operation indication. It is reasonable to combine both the condition of patients and mastery of doctor himself to choose suitable way.