三种不同全子宫切除术式临床分析

目的 探讨对子宫＞12孕周经腹、阴道、腹腔镜3种不同途径全子宫切除术式的临床选择.方法 回顾性分析对比153例子宫良性病变行子宫切除术式患者[经腹(TAH组)60例,经阴道(TVH组)26例,经腹腔镜(LTH组)67例]3种不同途径全子宫切除患者的病历资料,记录术中出血量、手术时间及术后发热率、排气时间、术后镇痛、术后住院时间和手术并发症发生情况.结果 3组手术时间及术中出血量无统计学意义(P＞0.05);TVH组术后排气时间较其他两组短,与TAH组比较差异有统计学意义[(42±10)h比(49±12)h;P＜0.05],TVH组和LTH组比较差异无统计学意义;术后住院时间TAH组明显长于TVH组和LTH组,差异有统计学意义[(5.6±1.6)d比(4.5±1.5)d、(4.0±1.0)d;P＜0.01];术后发热率TVH组明显高于TAH组和LTH组(30.8%比3.0%、6.7%;P＜0.01);术后镇痛率TAH组明显高于TVH组和LTH组(66.7%比19.2%、8.9%);术后并发症LTH组输尿管损伤1例,TVH组中转开腹1例.结论 LTH作为微创手术,有着传统开腹手术不可比拟的优点,但要严格掌握好手术指征,掌握手术技巧,根据具体情况选择手术方式,尽量避免严重副损伤的发生.LTH和TVH处理＜16孕周大子宫均是安全、可行的.

Clinical analysis of three different kinds of complete hysterectomy

Objective To investigate the clinical choices of three different kinds of complete hysterectomy through belly, vagina and laparoscope to uterus over 12 gestational weeks. Methods General data of 153 complete hysterectomy patients, including 60 cases through belly, 26 cases through vagina and 67 cases through laparoscope,were retrospectively analyzed. Bleeding amount, operation time, postoperative fever rate, exhaust time, postoperative analgesia, hospitalized time and operative complications were observed. Results The biggest uterus removed in transabdominal hysterectomy group was about(14.8 ±2.9) weeks and bigger than the other groups(P ＜0.01 or P ＜0.05). There was no statistical significance of the operation time and the amount of bleeding during operation among the three groups(P ＜0.05). The postoperative exhaust time of Group total vaginal hysterectomy(TVH) was shorter than that of the other two groups (P ＜ 0. 05). The postoperative hospitalized time of Group total abdorminal hysterectomy(TAH) was longer than that of other two groups(P ＜0.01). The postoperative morbidity of Group TVH was higher than that of other two groups(30.8%). The postoperative analgesia of Group TAH was obviously higher than that of other two groups(66.7%). For the postoperative complication, there was one case of ureter injury for Group total laparoscopic hysterectomy (LTH) and one case of open-belly operation for Group TVH. Conclusions As a minimally invasive surgery, TLH has incomparable advantages over traditional open-belly operation, but it needs strict control of operation indication and good operation technology. In order to prevent serious side-injury, we should choose right operation way according to the actual situation. TLH and TVH are safe and practical for the operations of big uterus.