三种不同途径的子宫切除术手术结果评价

目的 比较非脱垂子宫经阴道子宫切除术、腹腔镜辅助下经阴道子宫切除术及经腹子宫切除术的手术结果。方法 有子宫切除指征的非脱垂子宫经阴道子宫切除术患者66例，腹腔镜辅助下经阴道子宫切除术患者47例，经腹子宫切除术患者50例，比较3组患者的手术时间、术中估计出血量，手术前、后Hb下降值及术后肠蠕动恢复时间、术后发热率、术后出院时间等各项指标。结果 腹腔镜组手术时间显著长于经阴道子宫切除术组和经腹子宫切除术组（P＜0．05）；术中估计出血量各组之间差别无显著性意义（P＞0．05）；术前、后血Hb下降值腹腔镜组略高于经阴道手术组和经腹手术组（均P＜0．05）；术后肠蠕动恢复时间、术后发热率、术后出院时间等指标腹腔镜组和经阴道手术组均显著低于经腹手术组（P＜0．05）。结论 经阴道子宫切除术和腹腔镜辅助下经阴道子宫切除术与经腹手术相比，具有术后恢复快，发热病例少，住院时间短，腹部不留疤痕或疤痕很小，符合微创手术原则，均可称为微创性子宫切除术。

Outcome of hysterectomies through three different surgical routes

Objectives To evaluate the outcome of hysterectomies by three different surgical routes:vaginal hysterectomy,laparoscopy-assisted vaginal hysterectomy and abdominal hysterectomy.Methods Data were collected prospectively from 66 women who underwent vaginal hysterectomy,47 women who underwent laparoscopy-assisted vaginal hysterectomy and 50 women who underwent abdominal hysterectomy.Such indices as operating time,estimated blood loss,postoperative hemoglobin drop,recovery time of peristalsis,postoperative fever rate,length of stay were compared among three groups.Results The operating time of laparoscopy assisted vaginal hysterectomy group was significantly longer than vaginal hysterectomy and abdominal hysterectomy groups(P<0.05).There was no significant difference of estimated blood loss among three groups(P>0.05).The postoperetive hemoglobin drop of laparoscopy assisted vaginal hysterectomy group was siginficantly greater than that of vaginal hysterectomy and abdominal hysterectomy groups(P<0.05).The recovery time of peristalsis and the length of stay of adbominal hysterectomy group were significantly longer and the postoperative fever rate was higher than those of laparoscopy assisted vaginal hysterectomy and vaginal hysterectomy groups(P<0.05).Conclusion Compared with abdominal hysterectomy,vaginal hysterectomy and laparoscopy assisted vaginal hysterectomy are associated with faster convalescence,less febrile morbidity,shorter hospitalization,no or only small abdominal incision.Both may be called as mini-invasive hysterectomies.