电视腹腔镜子宫切除术与阴式、腹式子宫切除术的临床评价

CLINICAL EVALUATION: LAPAROSCOPIC ASSISTED TRANSVAGINAL HYSTERETOMY VERSUS VAGINAL HYSTERECTOMY AND LAPAROHYSTERECTOMY

本文对腹腔镜辅助阴式子宫切除术、阴式于宫切除术、腹式子宫切除术三组术式进行临床评价。每组10例,对其手术指征、腹腔镜组、腹式组以子宫肌瘤、卵巢肿瘤为主各为90％、100％,而阴式组则以子宫脱垂为主占100％(P值<0.001)。 腹腔镜组还能同时行胆囊切除术占30％。所切除子宫大小阴式组小于正常子宫占90％,而腹腔镜组、腹式组均超过正常子宫大小(P<0.001)。 术后肠功能恢复在24h之内,腹腔镜组占100％、阴式组占80％、腹式组占20％(P<0.001)。腹腔镜组术后无需用镇痛剂。 术后住院日腹腔镜组平均5天与腹式组平均7.3天比较,P<0.001。得出腹腔镜辅助阴式子宫切除术兼阴式、腹式子宫切除术的优点。虽然出现2例非损伤性并发症,但只要仔细操作,该项手术在妇科手术领域有很大空间。

Objective:To evaluate the indication, technical procedure and the clinical value of laparo-scopic assisted transvaginal hysterectomy (LAVH) and transvaginal hysterectomy, laparohysterectomy. Methods: Thirty patients suffered from various kind of benign gynecological disease underwent the operation from July, 1997 to July, 1998. Ten patients underwent LAVH. Other ten underwent vaginal hysterectomy. The remain ten underwent laparohysterectomy. 9 patients (90%) of the ten who underwent LAVH had leiomyoma or ovaria neoplasms. Patients who underwent laparohysterectomy all had leiomyoma or ovarian neoplasms. Patients who underwent vaginal hysterectomy all had uterine prolapse. (P <0.001) The vaginal hystrectomy was confined to do uterine section only. LAVH and laparotomy could resect the ovarian tumor at the same time. Results: The intestinal function recovered within 24 hrs in the whole LAVH group (100 %), while in the vaginal group, it was 80 % . And in the laparotomy group, it was only 20 % (P <0. 01). There was a statistically significant difference in average hospitalization day between laparoscopic and laparotomy;5 days versus 7. 3 days. ( P < 0. 001). Conclusion: LAVH avoids laparotomy and lessen injuries, shortens the hospitalstay, expands the indication of transvaginal hysterectomy.