全子宫切除的三种手术途径的临床应用

Clinical study on three different operation procedure for hysterectomy

目的比较全子宫切除术三种手术途径的临床效果。方法收集2000年1月至2005年12月在我院进行三种手术途径全子宫切除术病例共370例的临床资料,其中经腹全子宫切除术150例(TAH组),非脱垂子宫经阴道全子宫切除术120例(TVH组),腹腔镜辅助阴道全子宫切除术100例(LAVH组),比较三组术中情况、术后恢复情况及医疗费用等。结果平均手术时间TAH组为(78±28)min,明显短于TVH组(102±35)min及LAVH组(119±28)min,差异有统计学意义(P＜0．01)；平均术中出血量TAH组为(53±29)ml,明显少于TVH组(110±35)ml及LAVH组(93±50)ml,差异有统计学意义(P＜0．01)；平均术后肛门排气时间TAH组为(42±7)h,明显迟于TVH组(23±5)h及LAVH组(25±4)h,差异有统计学意义(P＜0．01)；平均术后住院天数TAH组为(8．9±1．1)d,明显多于TVH组(5．7±2．4)d及LAVH组(6．3±1．9)d,差异有统计学意义(P＜0．01)；平均住院费用LAVH组为(7 273±938)元,明显高于TAH组(5594±308)元及TVH组(5450±167)元,差异有统计学意义(P＜0．01)；手术副损伤及术后病率三组相比较差异无统计学意义。结论不同途径子宫全切除术各有优势,也各有局限性,不能相互替代,应根据患者的身体情况及经济状况、手术医生的技术水平及医院的技术条件等综合考虑。

Objective To investigate the effects of three procedures for hysterectomy. Methods The clinical characteristics of 370 cases who respectively received hysterectomy by total transabdominal hysterectomy（TAH, 150 cases）, transvaginal hysterectomy （ TVH, 120 cases）, or laparoscopically assisted vaginal hysterectomy （ LAVH, 100 cases） were analyzed and their effects and outcomes and the expenses for medical treatment were compared from 2000 January to 2005 December. Results The average operation time of TAH,TVH and LAVH was （78± 28） minutes, （ 102 ± 35） minutes, （ 119± 28） minutes respectively. The average operation time of TAH was significantly shorter than that of TVH and LAVH groups（ P 〈 0.01 ）. The volume of hemorrhage during operation in TAH group was less than that of other two groups significantly[ TAH （ 53 ±29 ） ml, TVH （ 110 ±35 ） ml, LAVH （ 93 ± 50 ） ml ] （ P 〈 0.01）. The average time of bowel function recovery in TAH group[ （42± 7） hours] was significantly longer than that of TVH[ （23 ± 5） hours] or LAVH[ （25± 4） hours] groups（P〈 0.01 ）. The average hospital stay after operation in TAH[ （8.9 ± 1.1 ） days] group was significantly longer than that of TVH[ （5.7± 2.4） days] or LAVH [ （6.3 ± 1.9） days] groups（ P 〈 0.01 ）. The average expenses for medical treatment in LAVH[ （ 7273 ± 938） yuans] group was significantly more than that of TAH[ （5594 ± 308） yuans] or TVH[ （5450 ± 167） yuans] groups（ P 〈 0.01）. But the lesion and the complication after operation of three groups had no difference. Conclusion Different procedures for total hysterectomy have their own advantage and disadvantage. The operation procedure must take account of the economy,echnique of medical treatment and the condition of the hospital.