阴式大子宫切除术25例临床分析

Vaginal Hysterectomy for Large Uterus

目的 探讨阴式大子宫切除术的方法和经验。方法 在１９９７ 年９ 月至１９９８ 年１ 月对２５ 例子宫增大如６ ～１６ 孕周、活动、估计无粘连的子宫肌瘤、肌腺病患者，行阴式子宫切除术。减小子宫体积的手术方法包括子宫对半切开、子宫肌瘤切除、子宫分碎、子宫肌瘤剔除术，其中最常用的方法是子宫对半切开、肌瘤剔除及分碎的结合使用。结果 ２４ 例经阴道手术成功，平均子宫重量为３６０ ｇ（１５５ ～７５５ ｇ） ，平均手术时间为９５ 分钟（６０ ～１５０ 分钟） ，平均估计失血量为１５０ ｍｌ（５０ ～４００ ｍｌ） 。术后出院时间平均为５ ．３ 天（３ ～８ 天） 。结论 经阴道切除较大的子宫是有效和安全的手术，手术的成功与子宫大小、活动度及术者的经验和技术等有关。

Objective The technique and experience of vaginal hysterectomy for large uterus of 25 cases was reported. Methods Vaginal hysterectomy for 25 cases of uterine fibroids and adenomyosis were performed. The uterine sizes enlarged as large as 6～16 weeks of pregnancy, mobile, no adhesion by estimation. The technique used for reducing the uterine bulk included bisection, myomectomy, morcellation and coring. The most common way to reducing the uterine bulk was bisection combined with myomectomy and morcellation. Results Twenty four cases of vaginal hysterectomy were performed successfully. The average weight of uterus for the 25 cases was 360 g(range from 155 g to 755 g), the mean time for the operation was 95 minutes(range from 60 to 150 minutes), the average quantity of blood loss was 150 ml (range from 50 to 400 ml), the average admission duration of postoperation was 5.3 days(range from 3 to 8 days ). Conclusion Vaginal hysterectomy is a safe and effective option for removing enlarged uterus. The successful operation was related to the uterine sizes, mobile, operator' skill and experiences.