不同途径全子宫切除术临床效果分析

目的：探讨不同途径全子宫切除术的临床效果。方法：回顾性分析602例子宫全切除术患者的临床资料，其中行传统腹式子宫全切除术（TAH）273例、阴式子宫全切除术（TVH）166例、腹腔镜辅助阴式子宫全切除术（LAVH）51例和腹腔镜子宫全切除术（TLH）112例，比较各组患者术中及术后情况。结果：TAH、TVH组平均手术时间显著短于TLH、LAVH组，差异有统计学意义（P〈0．05）；术中平均出血量相比较，LAVH组显著高于其他三组，差异有统计学意义（P〈0．05）；术中并发症主要有出血和脏器损伤，TAH组明显少于LAVH（P=0．022）；术后使用抗生素的时间比较，LAVH组显著长于TVH、TLH组，差异有统计学意义（P〈0．05）；LAVH组术后体温升高的发生率显著高于其他3组（P〈0．05）；平均治疗费用比较，LAVH组与TLH组间无显著差异（P〉0．05），但显著高于其他2组（P〈0．05），TVH组明显低于其他3组，差异有统计学意义（P〈0．05）；术后住院时间比较，TAH组明显长于其他三组（P〈0．05），TLH组显著短于LAVH组（P〈0．05）；肛门排气时间比较，TAH组明显长于其他三组，差异有统计学意义（P〈0．05），LAVH组与TLH组相比无显著差异（P〉0．05）。结论：不同途径子宫全切除术各有优势，且互不能完全替代，应根据患者的情况、手术医生的技术水平、医院的条件等综合考虑，尽量选择微创、经济的方式。

Clinical Study on the Hysterectomy with Different Operation Procedures

Objective： To investigate the effects of four procedures for hysterectomy. Methods： Retrospectively,the clinical characteristics of 602 cases respectively releiving hysterectomy,including total abdomino hystereetomy（TAH, 273 cases）, transvaginal hystereetomy（TVH, 166 case）, laparoscopie assisted vaginal hysterectomy（LAVH,52 cases） and total laparoscopical hysterectomy（LTH, 112 cases） were analyzed,and the effects were compared. Results： The average operation time of TAH （83 ±26 minutes） and TVH （70 ± 46minutes） was significantly less than that of TLH （121 ± 37minutes） and LAVH （119 ± 36 minutes） （P 0.05）. The volume of hemorrhage during operation in LAVH group （215± 16）ml was more than that of other three groups significantly（P〈0.05）. The main complications during operation included hemorrhage and the damage on visceral organ. The complications occoured in TAH group were less than that in the other three groups significantly （P=0.022）. The average time of antibiotic administration and the incidence of fever in LAVH group were significantly longer than that of other three groups. The average cost of LAVH group was similar to that of TLH group, but was significantly more than that of other two groups（P〈0.05）, while the average cost of TVH group was less than that of the other three groups significantly（P〈0.05）. According to the average hospital-duration after operation,TAH group was longer than other three groups（P〈0.05） ,while TVH group was shorter than LAVH group（P〈0.05） significantly. As far as bowel function recovery was countered,TAH groups was significantly longer than other three groups （P〈 0. 05）, while TLH and LAVH groups had no significant difference（P〉 0. 05）. Conclusion： Different procedures for total hysterectomy have their own advantages and disadvantages. Considering the conditions of patients, hospital and technical level, a microinvasive and economical surgery should be chosen.