有剖宫产术史患者阴式子宫切除术临床分析

Clinical study of transvaginal hysterectomy in patients with previous history of cesarean section

目的探讨有剖宫产史的患者选择阴式子宫切除术的可行性及安全性。方法回顾性分析2000年1月至2005年1月行阴式子宫切除术中的196例病例,其中有剖宫产史的72例定为A组,无腹部手术史的70例为B组,除外剖宫产的腹部手术史54例为C组。分别就手术时间、术中出血量、子宫体积及住院日进行比较。结果A组手术时间(80±26)m in,B组(68±22)m in,C组(70±16)m in,A组明显长于B组或C组(P<0.05),B组与C组手术时间相似(P>0.05)。A组子宫体积(354.2±203.6)cm3,B组(469.2±269.3)cm3,C组(425.6±196.3)cm3,A组较B、C两组均小(P<0.05),B组与C组子宫体积相似。术中出血量及住院日3组间差异无统计学意义。A组2例膀胱损伤。结论有剖宫产史者的患者选择阴式子宫切除术是可行的。

Objective To assess the feasibility and safety of transvaginal hysterectomy （TVH） in patients with a previous history of cesarean section. Methods 196 women undergoing TVH were included in a retrospective study from January 2000 to January 2005. They were assigned to three groups, group A （72 cases,with a previous history of cesarean section）, group B （70 cases, without a history of abdominal operation） and group C （54 cases ,with a history of abdominal operation except cesarean section）. The operation time, uterine size, bleeding during operation and hospitalization duration were compared among the groups. Results The operation time of group A was （ 80 ± 26） minutes ,group B （68 ±22） minutes,group C （70 ± 16） minutes. The operation time of group A was significantly longer than that of group B or group C （P 〈 0.05） ,without a significant difference between group B and group C （P 〉 0.05）. The uterine size was （354.2 ± 203.6） cm^3 in group A, （469.2 ± 269.3） cm^3 in group B, （425.6 ± 196.3 ） cm^3 in group C. The uterine size of group A was significantly smaller than that of group B and group C （ P 〈 0.05 ）, without a significant difference between the two groups. There were no difference of the bleeding volum during operation and hospitalization duration among the groups. There were 2 cases of incidental in group A. Conclusion The patients who have a previous history of cesarean section can undergo transvaginal hysterectomy.