改良腹腔镜下阴式子宫切除术治疗大子宫肌瘤的临床分析

目的:观察改良腹腔镜辅助下阴式子宫切除术(laparoscopy-assisted vaginal hyterectomy,LAVH)与阴式子宫切除术(through vaginal hysterectomy,TVH)治疗大子宫肌瘤(子宫≥ 12孕周)的临床效果。方法:收集因大子宫肌瘤(或合并子宫腺肌病)行子宫切除术患者的临床资料,其中行改良LAVH 36例,并随机抽取行TVH者36例作为对照,比较手术时间、术中出血量、术后最高体温、肛门排气时间、术中及术后并发症。结果:改良LAVH组和TVH组相比,手术时间明显缩短,术中出血量明显减少(P<0.01),术后最高体温和肛门排气时间差异均无统计学意义(P>0.05)。TVH组中发生肠管损伤1例,开腹修补;发生阴道残端大出血2例,行再次阴道探查止血。改良LAVH组均顺利完成手术,未发生并发症。结论:改良LAVH降低了阴式手术的难度,节省手术时间,对于基层医院有广阔的应用前景。

Reformed laparoscopy-assisted vaginal hysterectomy for treatment of big myoma

Objective： To compare the clinical results of modified laparoscopy-assisted vaginal hysterectomy （LAVH）and through vaginal hysterectomy（TVH） in treatment of big myoma （ ≥12 gestation weeks）. Methods：The clinical data of cases with big myoma who had undergone uterus hysterectomy in 2008 in the First People＇s Hospital of Shanghai were collected. Thirty-six cases were treated by LAVH and 36 cases by TVH. The operation time, blood loss in the operation, body temperature and passage of gas by anus after the operation were analyzed and compared between the two groups. Results： The operation time and bleeding in the operation were decreased obviously in the modified LAVH group compared with those in the TVH group （ P 〈 0.01 ）. But the body temperature and passage of gas by anus after operation were not statistically different between the two groups （ P 〉 0.05 ）. In TVH group, rectum injury was observed in 1 case, which was mended by cutting the abdomen operation, and vaginal stump bleeding was noted in 2 cases, which was managed after reexamination through the vagina. The operation was all successful in the modified LAVH group and no complication occurred. Conclusions： Reformed LAVH makes the operation less difficult and shortens the operation time, which promises a wide prospect in the basal hospitals.