阴式子宫全切术与经腹及腹腔镜下术式比较分析

目的 比较经腹全子宫切除术(TAH)、非脱垂子宫经阴道全子宫切除术(TVH)、腹腔镜辅助阴式子宫全切术(LAVH)的临床特点及临床效果.方法 对本院2010年1月至2010年11月因子宫良性疾病需行子宫切除术的396例病例进行回顾性分析.其中TAH术式185例、TVH术式151例、LAVH术式60例.对三种术式手术时间、术中出血、术后镇痛、术后并发病率和住院时间进行比较.结果 LAVH组手术时间(82 9±15 9)min,较TVH组的(43 6±13 2)min和TAH组的(56 3±11 2)min手术时间延长(P<0 01);TAH组、LAVH组、TVH组术后镇痛率依次递减(P<0 05);住院时间TVH组(3 5±1 8)d,与LAVH组、TAH组差异有统计学意义(P<0 01).三种术式术后并发病率比较差异无统计学意义.结论 TVH术式手术时间短、出血少、住院时间短,术后镇痛率低,与 TAH术式和LAVH术式相比各有优点,子宫体积<孕4+月时可利用TVH术式.临床应根据不同情况选择不同的子宫切除方式,以达到最佳治疗效果.

Comparison study on the total abdominal hysterectomy (TAH),transvaginal hysterectomy (TVH) and laparoscopically assisted vaginal hysterectomy

Objective To compare the operative time, blood loss, hospitalization day, postoperative analgesic and postoperative morbidity in total abdominal hysterectomy（TAH）, transvaginal hystereetomy（TVH） and laparoscopieally assisted vaginal hysterectomy （LAVH）. Methods A total of 396 patients with benign uterine disease, who underwent TAH, TVH or LAVH in The First People＇s Hospital Zhuzhou China from July 2010 to Dec 2010, were retrospectively studied （ 185 patients with TAH, 151 cases with TVH and 60 cases with LAVH ）. Results The operation time （ 82.9 ± 15.9 ） rain in LAVH was significantly longer than that in TAH （43.6 ± 13.2 ） min and TVH （ 56. 3 ± 11.2 ） rain respectively （ P 〈 0. 01 ）. Blood loss and hemoglobin decrease in LAVH group was significantly greater that those in TAH or TVH （ P 〈0. O1 respectively）. The rate of postoperative analgesic in TAH was higher than those in TVH or in LAVH（ P 〈 0. 05,respectively）. There was significant difference between the abdominal vaginal and LAVH in hospital stay （P 〈 0. 01 ）. No significant difference was found among these three groups in the pyrexiarate （ P 〉 0.05 ）. Conclusion The operation of TVH takes shorter time and less blood loss than that for TAH and LAVH, except it has the same merits of others. TVH would be a good choice for the size of uterus less than that of a 4 month pregnancy. The keys to success in LAVH should include doctor＇s skills and appropriate indications. It is reasonable to choose the pattern of hysterectomy according to the practical conditions of patients.