三种腹腔镜全子宫切除术术式比较

目的 比较性研究3种腹腔镜全子宫切除术：完全腹腔镜全子宫切除术（TLH）和两种腹腔镜辅助阴式全子宫切除术（LAVH）的特点。方法 回顾性分析了2002年9月-2005年9月间在我院行腹腔镜全子宫切除术393例患者的临床资料,其中TLH178例,LAVHa177例,LAVHb38例。结果 各组均以子宫肌瘤、子宫腺肌症为最常见病因,在TLH组、LAVHa组和LAVHb组分别占66．9％、38．4％和52．6％。TLH组在平均手术时间和出血量上与LAVHa组相比差异无显著性（P〉0．05）,但较LAVHb组少（P〈0．05）;TLH组切除子宫的体积显著大于其他两组（P〈0．05）。手术并发症发生率在TLH组为9．0％,低于LAVHa组（14．1％）和LAVHb组（18．4％）,但无统计学差异（P〉0．05）。结论 TLH组切除的子宫体积较大,不影响出血量和手术时间,且并发症较少。

Comparison of three subcategories of laparoscopic hysterectomy

Objective To compare the clinical characteristics of three subcategories of laparoscopic hysterectomy: total laparoscopic hysterectomy (TLH) and two subcategories of laparoscopic-assisted vaginal hysterectomy (LAVH): LAVHs and LAVHb. Methods We retrospectively analyzed the clinical data of 393 patients underwent laparoscopic hysterectomy, including TLH (n=178), LAVHa (n=177), and LAVHb (n=38),in our hospital from September 2002 to September 2005. Results Myoma and adenomyosis of uterus were the most common diseases in this study, accounting for 66.9%, 38.4%, and 52.6% in TLH group, LAVHa group, and LAVHb group, respectively. The mean surgery duration and blood loss were not significantly different between TLH group and LAVHa group (P>0.05), but were significantly less in TLH group than in LAVHb group (P<0.05). The bulk of uterus in TLH group was significantly bigger than in other two groups (P<0.05). The incidence of major complications in the TLH group (9.0%) was lower than in LAVHa group (14.1%) and in LAVHb group (18.4%), but without statistical significance. Conclusion Compared with LAVH, TLH is feasible to deal with bigger uterus with less blood loss and shorter surgery duration and without more frequent complications.