非脱垂大子宫经阴道切除88例临床研究

Clinical study on transvaginal hysterectomy for non-prolapse and large uterus

目的:研究非脱垂大子宫经阴道切除的临床可行性。方法:采用子宫劈开、肌瘤剜除、碎解、去核等缩小子宫体积的方法,对88例非脱垂子宫增大如6～18孕周、重138～741g的子宫肌瘤、子宫肌腺症患者行经阴道子宫切除术。结果:84例经阴道切除,成功率95.5%。子宫平均重量362g(138～741g),平均手术时间98分钟(40～135分钟),平均失血量234ml(50～600ml)。术后住院时间平均5.4天(4～9天)。术后病率2.3%。结论:研究结果表明,非脱垂大子宫经过有效的缩小子宫体积多可经阴道安全切除。选择手术时不仅要注意子宫的绝对大小,还需充分注意子宫的形态及活动度。手术的成功与术者经验和技术密切相关。

Objective:To investigate the feasibility of transvaginal hysterectomy for non-prolapse and large uterus. Methods:Eighty-eight transvaginal hysterectomies were performed for non-prolapse and enlarged myomatous uteri or adenomyosis, with the size equivalent to 6～18 gestational weeks or 138～741g. Bisection, enucleation, morcellation, coring and combination thereof were used to facilitate the operation by reducing the uterine volume. Results: It showed that 84 cases of vaginal hysterectomy were performed successfully. The average weight of the uterus for the 88 cases was 362g (range from 138 to 741g), the mean time for the operation was 98 minutes (range from 40 to 135 minutes), the average volume of blood loss was 234 ml(range from 50 to 600ml). The morbidity rate was as low as 2.3% and the average postoperative hospital stay was 5.4 days(range from 4 to 9 days). Conclusion:These data suggest that non-prolapse and enlarged uterus can be safely removed transvaginally through reduction of the uterine volume. Not only the size, but also the shape and the mobility of the uterus should be considered when indication for transvaginal hysterectomy existed. The successful operation was closely related to the operator's skill and experiences.