644例非脱垂大子宫经阴道切除临床总结分析

Clinical Analysis of Trans-vaginal Hysterectomy for 644 Large Volume, Non-prolapse Uterus

目的 :探讨非脱垂大子宫经阴道切除的可行性与安全性。方法 :对 6 4 4例子宫超过 10周孕大小的患者施行经阴道子宫切除术。患者平均年龄 4 2 5岁 ,包括子宫肌瘤 4 74例 ,子宫腺肌病 170例。术前检查子宫 10～ 12周孕大小者 172例 ,>12～ 14周孕者 2 0 1例 ,>14～ 16周孕者 175例 ,超过 16周孕者 96例。结果 :6 4 4例中除 1例因术中发现肌瘤肉瘤样变而改开腹手术外 ,余 6 4 3例均成功行阴式子宫切除术 ,成功率达 99 8%。子宫平均重 370 7g(16 5～ 10 80g) ,平均手术时间 6 0 2分钟 (32～ 98分钟 ) ,术中平均出血量 15 0 4ml(5 0～ 30 5ml) ,术后肠道功能恢复时间平均 1 5天 (2～ 3天 ) ,留置尿管 2 4小时 ,阴道流液时间平均为 1 6天 ,体温恢复正常时间平均 3 6天 (1～ 5天 ) ,术后住院时间平均为 4 8天 (4～ 7天 )。结论 :适当的病例选择加上灵活的手术技巧 ,非脱垂大子宫经阴道切除是安全可行的。

Objective: To explore the feasibility and safety of transvaginal hysterectomy (TVH) for large volume, non-prolapse uterus. Methods:Six hundred and forty-four patients underwent transvaginal hysterectomy, whose uterine volume larger than 10 gestational weeks caused by different gynecological diseases, including 474 cases of uterine myoma and 170 cases of adenomyosis. The patients were divided into 3 groups according to the size of the uterus: 10～12 gestational weeks (172cases),>12～14 gestational weeks (201cases),>14～16 gestational weeks (175cases), and >16 gestational weeks (96cases). Results: The success rate of TVH was 99.8% except one case turned to transabdominal surgery because of unexpected uterine sarcoma. The mean weight of removed uterus in 643 cases of TVH was 370.7 g (165～1080 g), the average operation time and the operative bleeding were 60.2 min (32～98 min) and 150.4 ml (50～305 ml) respectively. The mean post-operation vaginal discharge disappeared in 1.6 days. The mean recovery time of bowel and bladder function were 1.5 days (2～3days) and 1day, respectively. The mean times of temperature normalization and hospitalization were 3.6 days (1～5days) and 4.8 days (4～7days), respectively. Conclusions: Trans-vaginal hysterectomy for large volume, non-prolapse uterus is safe and feasible in selected patients.