剖宫产手术史患者微创全子宫切除术的可行性分析

目的:探讨既往有剖宫产手术史,行阴式全子宫切除术(TVH)及腹腔镜下全子宫切除术(LTH)的可行性及利弊分析。方法:回顾性分析2012年至2017年,既往有剖宫产手术史,无阴道分娩史,因良性疾病行全子宫切除术的患者,选取开腹全子宫切除术组(TAH)100例,TVH组100例,LTH组100例,对比分析三种术式的临床资料,进行统计学分析。结果:手术时间方面,TVH组手术时间最短,LTH组手术时间最长,三组之间均有统计学差异(P<0.001)。LTH组出血量最少,与TAH组之间有统计学差异(P<0.05)。TVH组术后排气时间最短,TAH组术后排气时间最长,三组之间比较均有统计学差异(P<0.001)。结论:剖宫产术后,行阴式及腹腔镜全子宫切除术是可行的,而阴式全子宫切除术在手术时间、术后排气时间等方面均优于开腹及腹腔镜全子宫切除术,腹腔镜全子宫切除术出血量最少,两组均未增加副损伤及并发症。

Feasibility and benefits of minimally invasive total hysterectomy for patients with a history of cesarean section

Objective:To evaluate the feasibility of transvaginal hysterectomy and laparoscopic total hysterectomy in benign uterine disease among patients who had a history of cesarean section.Methods:A retrospective review of medical records of patients with a previous cesarean section and without history of vaginal delivery who underwent a hysterectomy between 2012 and 2017 was conducted.Patients were divided into three groups:Transabdominal hysterectomy（TAH) group,transvaginal hysterectomy（TVH) group,and laparoscopic total hysterectomy（LTH) group.Results:A total of 300 patients with previous cesarean section underwent hysterectomy.The mean operation time was the shortest in the TVH group compared to the other two groups（all P＜0.001).The mean postoperative first flatus was also the earliest in the TVH group,and the mean blood loss was the least in LTH group,whereas the most blood loss and last flatus were in the TAH group.Conclusion:It is feasible to conduct TVH and LTH in patients with a history of cesarean section.TVH is completely superior to LTH and TAH in operation time and postoperative flatus,and the LTH group has the least blood loss,without increasing vice damage and complications.