4种子宫切除术的临床探讨

目的:探讨经腹子宫全切除术(TAH),阴式子宫全切除术(TVH)、经腹腔镜辅助的阴式子宫全切术(LAVH)和经腹腔镜子宫全切术(TLH)4种术式的临床应用效果。方法:对2004年1月～2010年9月在本院因子宫疾病分别采用4种手术方式切除子宫1000例,比较手术时间、出血量及术后情况。结果:手术时间TLH组(127.50±28.76min)显著长于TAH组(80.56±25.21min)、TVH组(74.28±10.45min)和LAVH组(68.12±18.34min);术中出血量TAH组(156.25±54.82ml)多于TVH组(63.20±13.25ml)、LAVH组(76.30±18.46ml)和TLH组(126.94±21.35ml);术后排气时间TAH组(38.56±8.46h)显著晚于TVH组(23.12±7.36h)、LAVH组(20.45±5.68h)和TLH组(23.45±5.68h);术后住院时间TAH组(7.24±1.02d)长于TVH组(5.25±0.25d)、LAVH组(4.02±0.32d)和TLH组(4.50±0.82d);术后镇痛使用率TAH组(99.4%)高于TVH组(28.3%)、LAVH组(22%)和TLH组(30%)。术后病率TAH组最高,与其他3组比较,差异均有统计学意义(P<0.05)。结论:4种术式均为子宫切除的有效术式,TVH、LAVH及TLH创伤小,术后恢复快。应根据患者病情,医生掌握手术方式熟练程度、手术设备综合考虑选择术式。

Clinical observation of four kinds of hysterectomy

Objective：To evaluate clinical effects of four kinds of hysterectomy,total abdominal hysterectomy（TAH）,total vaginal hysterectomy（TVH）,laparoscopic-assisted vaginal hysterectomy（LAVH）and total laparoscopic hysterectomy（TLH）.Methods：One thousand women who underwent hysterectomy for uterine diseases in Yuhang hospital from January 2004 to September 2010 were recruited.Lengths of operation,amount of bleeding and post-operation conditions were compared.Results：The length of operation in the TLH group [（127.50±28.76）min] was significantly longer than those of the other three groups [（80.56±25.21）min in the TAH group,（74.28±10.45）min in the TVH group,（68.12±18.34）min in the LAVH group].The amount of bleeding during operation in the TAH group [（156.25±54.82）ml] was more than those of the other three groups [（63.20±13.25）ml in the TVH group,（76.30±18.46）ml in the LAVH group,and（126.94±21.35）ml in the TLH group].The postoperative exhaust time of the TAH group [（38.56±8.46）h] was significantly later than those of the other three groups [（23.12±7.36）h in the TVH group,（20.45±5.68）h in the LAVH group,and（23.45±5.68）h in the TLH group].The length of hospital stay in the TAH group [（7.24±1.02）d] was longer than those of the other three groups [（5.25±0.25）d in the TVH group,（4.02±0.32）d in the LAVH group,and（4.50±0.82）d in the TLH group].The postoperative analgesia drug requirement of the TAH group（99.4%）was greater than those of the TVH group（28.3%）,the LAVH group（22.0%）,and the TLH group（30.0%）.Postoperative morbidity of TAH group（15.43%）was significantly more than those of the TVH group（6.33%）,the LAVH group（6.00%）,and the TLH group（7.00%）.Conclusion：TVH,LAVH and TLH have less injury and rapid recovery.They should be chosen according to the features of disorders,proficiency of the doctors on the operation skill and surgical equipments.