肥胖妇女阴式与腹式子宫全切术的比较

Vaginal versus abdominal total hysterectomy in obese women

目的探讨肥胖症患者子宫全切术时手术方式的选择。方法对BMI≥28kg/m2,有全子宫切除指征的116例肥胖症的临床资料进行回顾性分析,按手术方式分组,56例行阴式子宫全切术(阴式组),60例行腹式子宫全切术(腹式组)。比较2组术中、术后情况。结果阴式组手术时间(t=-3.693,p=0.000)、术中出血量(t=-4.006,P=0.000)、住院时间(t=-7.019,P=0.000)均较开腹组明显减少,阴式组术后病率、术后并发症发生率均较开腹组低(χ2=4.388,P=0.036;χ2=5.243,P=0.022)。结论肥胖妇女应优先选择阴式全切术,但粘连严重、有多次开腹手术史者应慎重。

Objective To discuss the selection of operation methods of total hysterectomy in obese women. Methods We reviewed clinical data of 116 obese women with the body mass index (BMI) ≥ 28 kg/m^2 treated with total hysterectomy. According to the operative procedure, 56 women underwent the vaginal total hysterectomy (Vaginal Group) and 60 women, abdominal total hysterectomy (Abdominal Group). Intra- and post-operative records were compared between the two groups. Results As compared with the Abdominal Group, the Vaginal Group presented a significantly shorter operation time (t=-3.693,P=0.000) and hospital stay (t=-7.019, P=0.000), a significantly less intraoperative blood loss (t=-4.006,P=0.000), and a significantly lower postoperative pyrexia rate (χ~2=4.388,P=0.036) and complication rate (χ~2=5.243,P=0.022). Conclusions Vaginal hysterectomy is superior to abdominal hysterectomy in obese women, but should be used with caution in those with severe adhesions or multiple abdominal operation history.