三种手术方式在大子宫切除中的临床效果分析

目的探讨传统开腹子宫全切术（TTAH）、改良开腹子宫全切术（MTAH）和腹腔镜下子宫全切术（TLH）在大子宫切除中的临床效果。方法回顾性分析80例大子宫切除的临床病例记录，包括手术时间、术中出血量、抗生素使用时间、并发症发生率、肛门排气时间、住院天数、住院费用，比较各组术中和术后情况。结果手术时间和术中出血量TLH大于TTAH和MTAH组（P〈0．05）。肛门排气时间和住院天数TTAH大于MTAH和TLH组（P〈0．05）。住院费用TLH〉TTAH〉MTAH组（P〈0．05），抗生素使用时间TTAH组稍长（P〈0．05），其他两组之间无统计学意义（P〉0．05）。并发症发生率三组之间无统计学意义（P〉0．05）。结论对于大于12孕周的子宫三种手术方式各有优势，且不可互相替代，结合患者情况，医院的医疗条件和技术水平等综合考虑，尽量选择微创和经济的手术方式。

Clinical study of three operation procedures for hysterectomy with large uterus

Objective To investigate the clinical result of traditional total abdomino hysterectomy （TYAH）, modified total abdomino hysterectomy （MTAH） and total laparoscopic hysterectomy （TLH） for large uterus hysterectomy. Methods Retrospectively, analysis the clinical records of 80 cases for large uterus hysterectomy, including operation time, bleeding volume, antibiotic administration time, the rates of complications occurred, bowel function recovery time, hospital - dura- tion and hospital - cost, and the pro - operation and post - operation effects were compared. Results The operation time and bleeding volume in TLH group were more than TTAH and MTAH groups （ P 〈 0.05 ）. The bowel function recovery time and hospital - duration in TTAH group were more than MTAH and TLH groups （ P 〈 0. 05 ）. The hospital - cost in TLH group was higher than that the other two groups, the MTAH group showed the cheapest hospital - cost in the three groups （ P 〈 0.05 ）. The antibiotic administration time in TTAH group was longer than that of the other two groups （ P 〈 0.05 ）. While the TLH and MTAH groups had no significant difference （ P 〉 0. 05 ）. The rates of complications occurred had no difference in three groups （ P 〉 0＇. 05 ）. Conclusion Three different operation procedures for total hysterectomy with more than 12 fetation week uterus have their own advantages and disadvantages, considering the conditions of patients, hospital and technical level, a micruinvasive and economical surgery should be chosen.