子宫体肌瘤保留子宫血管的阴式高位次全切除23例

Use of artery-sparing high-site transvaginal subtotal hysterectomy in 23 cases of uterine body leiomyoma

目的探讨子宫体肌瘤保留子宫血管的阴式高位次全切除术的临床价值。方法2002年1月～2004年12月，我院采用经阴道保留双侧子宫动脉上行支和子宫内膜的高位次全切除术治疗子宫体肌瘤23例，经阴道于膀胱宫颈间隙人路进入盆腔，翻出宫体（较大的宫体先挖出瘤体），在子宫角内侧1cm处，平行子宫侧壁（保留两侧子宫血管）向子宫峡部方向下切开子宫肌层达峡部上3cm，然后中部子宫前后壁肌层楔形切除，保留的子宫内膜2cm。结果23例经阴道完成手术，无一例中转开腹。手术时间45～80min，平均55min；术中出血量80-250ml，平均150ml。术后排气时间6～27h，平均11h；术后住院时间平均3-8d，平均4d；术后病率8．7％（2／23）。术后3个月恢复性生活18例。结论子宫体肌瘤保留血管的阴式高位次全子宫切除术安全可行、效果可靠、恢复快、并发症少，有很好的临床价值。

Objective To investigate the clinical value of artery - sparing high - site transvaginal subtotal hysterectomy （TVSH） for the treatment of uterine body leiomyoma. Methods High - site transvaginal subtotal hysterectomy with the preservation of bilateral uterine arteries was performed in 23 patients with uterine body leiomyoma from January 2002 to December 2004 in this hospital. The vesicouterine peritoneum was opened through the vagina to mobilize the uterus outside. With bilateral uterine arteries preserved, the muscular layer was opened 1 cm medial to the uterine horn until the site 3 cm above the isthmus of the uterus. Then wedge resection of the anterior and posterior uterine wall was conducted with the endometrium 2 cm in thickness preserved. Results All the operations were successfully completed without conversions to open surgery. The operating time was 45 - 80 min （ mean, 55 rain）, and the intraoperative blood loss was 80 - 250 ml （mean, 150 ml）. The time to first passing flatus was 6 -27 h （mean, 11 h）. The length of postoperative hospital stay was 3 -8 d （mean, 4 d）. The pyrexia rate after operation was 8.7% （2/23）. Normal sexual life recovered within 3 months in 18 patients. Conclusions Artery - sparing high - site TVSH has advantages of high safety, effectiveness, minimal invasion, rapid recovery, and fewer complications.