阴式与腹腔镜、腹式三种术式非脱垂子宫全切术后对盆底功能和性功能的影响

目的:探讨非脱垂子宫经阴道子宫全切除术(TVH)、腹腔镜子宫全切除术(LTH)(包括腹腔镜辅助下经阴道子宫全切除术,LAVH)及经腹子宫全切除术(TAH)术后对盆底及性功能的远期影响。方法:回顾性问卷调查1998年1月～2003年12月,8年间在该院和佛山市妇幼保健院收治的选择TAH、TVH、LTH(包括LAVH)不同术式的非脱垂子宫全切除术后患者1980例,实际随访人数1202例。其中包括TAH术后患者183例,TVH术后患者564例,LTH术后患者455例(包括LAVH术后患者197例)。从阴道顶端脱垂、性生活质量、更年期综合征(主要是血管舒缩症状)、压力性尿失禁四个方面比较三种术式术后对盆底及性功能的影响。结果:三种术式术后患者在56岁以上年龄区间,各项指标差别无显著性意义(P>0.05),而在55岁以下年龄区间,个别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:TVH与LTH(包括LAVH)和TAH在远期整体优势方面并无明显差别,而从综合角度考虑,TVH在大多数人群尤其是在围绝经期前患者还是具有一定的远期优势,是一种较理想的术式。

The long -term effect of postoperative on the pelvic floor and sex life among three surgical patterns of hysterectomy for uterine without prolapse: transvaginal hysterectomy, trans laparoscopic hysterectomy, trans abdominal hysterectomy

Objective:To evaluate the long-term postoperative effect on the pelvic floor and sex life among three surgical patterns of hysterectomy for uterine without prolapse.Methods:A total of 1 980 patients voluntarily chose hysterectomy from Jan.1998 to Dec.2003,during 8 years,in the maternal and children's health hospital of Foshan and this hospital,practical follow-up cases were 1 202,including 564 cases of transvaginal hysterectomy,183 cases of transabdominal hysterectomy,455 cases of trans-laparoscopic hysterectomy(including 197 cases of laparoscopically assisted vaginal hysterectomy).Results of the three operations for hysterectomy were analyzed and compared retrospectively,and detailed record were summaried in the following four points:top-vaginal prolapse,quality of sex life,menopausal syndrome(mainly vasomotion syndrome),and stress incontinence.Results:Over fifty-six years old,all index were no significant in the postoperative patients of three operations for hysterectomy(P>0.05).Under fifty-six years old,some index were significant lower in trans-laparoscopic hysterectomy group and transvaginal hysterectomy group than that in transabdominal hysterectomy(P<0.05).Conclusion:There is no significant difference in the long-term advantages of TVH,LTH(including LAVH) and TAH,but superiority of TVH is significant in the most,especially during menopansal period,it is an ideal route of approach.