改良大子宫腹腔镜辅助阴式切除术的临床研究

目的比较大子宫阴式切除术（TVH）与改良腹腔镜辅助下大子宫（子宫如孕12～20周）阴式切除术（LAVH）的临床效果。方法收集该院2006年1月至2009年6月接受不同途径大子宫切除术患者（170例）的临床资料，其中阴式大子宫全切除术78例（阴式组），改良腹腔镜辅助大子宫阴式全切除术92例（腹腔镜组），比较两组的手术时间、术中出血量、术后恢复情况。结果与TVH组相比，LAVH组中转开腹率低（0／92vs6／78，／=5．25，P〈0．05），手术时间短[（138±12．2）minvs（172±14．6）min，t=16．54，P〈0．01]，术后住院时间短[（5．6±1．3）dvs（7．8±3．5）d，t=5．60，P〈0．01]。两组术中出血量、术后病率、术后排气时间差异无显著性（P〉0．05）。结论LAVH扩大TVH的适应证，使大于孕12周子宫切除能在微创手术下顺利完成，是值得推广的手术方法。

Clinical study of big uterus reforming laparoscopcally assisted vaginal hysterectomy

Objective To compare clinical result of through vaginal hysterectomy (TVH)and modified laparoscope assisted vaginal hysterectomy(LAVH) for big uterus.Methods 170 cases of big uterus hysterectomy through vaginal or assisted vaginal hysterectomy from Jan 2006 to July 2009 were collected in our hospital.There were78 through vaginal hysterectomies( TVH groups)and 92 reforming laparoscope assisted vaginal hysterectomies( LAVH groups).operation time,bleeding volume and postoperative recovery of the patients were studied and compared between two groups.Results Compared with TVH group.there was a lower chance of abdominal hysterectomy ( 0/92 vs 6/78,χ2 = 5.25,P ＜ 0.05 ),a shorter operation time [( 138 ± 12.2 ) min vs ( 172 ± 14.6 )min,t = 16.54,P ＜ 0.01]and a shorter postoperative hospital stay[(5.6 ± 1.3 ) d vs(7.8 ± 3.5 ) d,t = 5.60,P ＜0.01]in the LAVH group.There were no significant differences in blood loss,morbidity and time to first flatus between the two groups.Conclusion The LAVH extends the indications of TVH,ensuring the safety of TVH for the uterus is bigger than that of 12 gestational weeks,therefore it is an operative procedure to be recommended.