大子宫微创手术的术式探讨

Evaluation on hysterectomy of gigantic uterus performed with minimally invasive surgery.

目的探讨超过妊娠12周的大子宫经阴道子宫切除及腹腔镜辅助经阴道子宫切除术的安全性及疗效。方法对我院120例超过妊娠12周的大子宫行全子宫切除术病例进行回顾性分析，其中开腹全子宫切除术60例、腹腔镜辅助阴式全子宫切除术35例、阴式全子宫切除术25例，比较分析术中、术后各项参数。结果阴式组手术时间长于开腹组和腹腔镜组（P〈0．01）；术中出血三组比较差异无显著性（P〉0．05）；腹腔镜组和阴式组术后恢复的各项指标均优于开腹组（P〈0．001）。结论对比开腹全子宫切除术和阴式全子宫切除术，大子宫经腹腔镜辅助全子宫切除术具有创伤小、腹壁切口小、术后恢复快等优点，但需手术医生同时具有熟练的腹腔镜下操作技术和阴式手术技巧。

Objective To evaluate the feasibility and effect of laparoscopic assisted vaginal hysterectomy （LAVH） and transvaginal hysterectomy（TVH） in patient whose enlarged uterus was over 12 gestational weeks. Methods The intra-and postoperative parameters of 35 cases performed LAVH and 25 cases performed vaginal hysterectomy is compared with those of 60 cases performed total abdominal hysterectomy （TAH）. Results Operation time of TVH group was longer than those of LAVH group and TAH group （P 〈0.01 ）. There was no significant difference in blood loss among three groups （ P 〉 0.05 ）. The postoperative parameters of LAVH group and TVH group were compared favorably with those of TAH （ P 〈 0. 001 ）. Conclusion Compared with TAH and TVH, LAVH has the advantage of less trauma, smaller abdominal incisions and rapid recovery. The surgeon must be experienced in both advanced operative laparoscopy and vaginal surgery.