阴式子宫切除术与腹腔镜辅助下阴式子宫切除术的比较

A comparison between transvaginal hysterectomy and laparoscopically assisted vaginal hysterectomy

目的比较阴式子宫切除术(TVH)与腹腔镜辅助下阴式子宫切除术(LAVH)的临床效果。方法TVH:切开阴道前后穹隆黏膜,进入腹腔,处理主、骶韧带,子宫动静脉。从前穹隆或后穹隆翻出子宫。处理输卵管、卵巢固有韧带、圆韧带,关闭腹腔,缝合阴道断端。LAVH:腹腔镜下处理圆韧带、输卵管、卵巢固有韧带,剪开膀胱反折腹膜,剪开阔韧带后叶,打开阴道后壁转入阴道操作,其他操作同阴式手术。结果与LAVH组相比,TVH组手术时间短[(75.6±30.2)m in vs(110.3±20.5)m in,t=-5.207,P=0.000],2组术后病率(TVH 6例,LAVH 8例,2χ=0.372,P=0.541)、术中出血量[(134.6±42.2)m l vs(141.8±45.2)m l,t=-0.638,P=0.526]、术后24 h镇痛情况(TVH 21例,LAVH 19例,2χ=0.300,P=0.584)、术后48 h排气(TVH 27例,LAVH 24例,2χ=0.523,P=0.470)、住院时间[(4.9±0.8)d vs(5.2±1.1)d,t=-1.208,P=0.232]无显著性差异。结论TVH手术时间短,创伤小,LAVH拓宽了阴式手术范围。

Objective To compare clinical effects between transvaginal hysterectomy （TVH） and laparoscopically assisted vaginal hysterectomy （LAVH）. Methods TVH Group： The mucous membrane of anterior and posterior vaginal fornix was opened for entering the abdominal cavity. The cardinal ligaments, uterosacral ligaments, and uterine arteries and veins were managed. The uterus was mobilized outside through the anterior or posterior fornix. After the oviducts, ovarian proper ligaments, and round ligaments were managed, the abdominal cavity was closed, and the vagina sutured. LAVH Group： Laparoscopically, the round ligaments, oviducts and ovarian proper ligaments were managed. Then the vesical peritoneal reflection, posterior broad ligament, and posterior vaginal wall were in turn opened for vaginal operation. The rest of procedures were the same as transvaginal surgery. Results The operating time was shorter in the TVH Group than in the LAVH Group （75.6 ±30.2 min vs 110.3 ±20.5 min; t = -5.207, P= 0. 000）. There were no significant differences between the two groups in the postoperative pyrexia rate （TVH Group： 6 cases, LAVH Group： 8 cases; χ^2 =0. 372,P =0. 541） , the intraoperative hemorrhage amount （ 134.6 ±42.2 ml vs 141.8 ±45.2 ml; t = -0. 638, P = 0. 526） , the analgesic use within 24 h after operation （ TVH Group ： 21 cases, LAVH Group ： 19 cases ; χ^2 = 0. 300, P = 0. 584 ） , the first passing flatus within 48 h after operation （TVH Group： 27 cases, LAVH Group： 24 cases; χ^2 =0. 523, P =0. 470） , and the length of hospital stay （4.9 ± 0.8 d vs 5.2 ± 1.1 d ; t = - 1. 208, P = 0. 232）. Conclusions TVH offers a shorter operating time than LAVH, while LAVH has a broader surgical indication than TVH.