三种术式子宫切除的效果比较

Comparison of Three Kinds of Hysterectomy

【目的】探讨经腹子宫全切术(TAH)、阴式子宫全切术(TVH)、腹腔镜辅助下阴式子宫全切术(LAVH)的特点及效果。【方法】回顾性分析2002年1月至2005年12月间TAH 1 060例、TVH 72例、LAVH 59例的临床资料。【结果】TAH组的手术时间(78.7±6.3)min显著短于TVH组(95.2±30.2)min和LAVH组(90.2±30.7)min;术中出血量LAVH组(100±55.1)ml和TVH(110±56.1)ml显著少于TAH组(139.3±7.8)ml;术后镇痛率TAH组(74.1%,785例)显著高于TVH组(20.8%,15例)和LAVH组(18.6%,11例);术后住院时间TAH组(12.1±1.1)d显著长于TVH组(8.5±4.2)d和LAVH组(5.5±1.3)d;术后发热率TAH组(5.9%,63例),TVH组(4.2%,3例),LAVH组(5.1%,3例)差异均无显著性。【结论】TVH和LAVH创伤小、病人痛苦少,术后恢复快。而LAVH适应的指征更宽。

[Objective]To compare the effects of transabdominal hysterectomy （TAH） , transvaginal hysterectomy （TVH） , and laparoscopic assisted vaginal hysterectomy （LAVH）. [Methods]Clinical data of 1060 cases of TAH （ TAH Group） , 72 cases of TVH （TVH Group） , and 59 cases of LAVH （LAVH Group） were retrospectively analyzed. [Results]The operation time was shorter in the TAH Group （78.7 ± 6.3）min than in the TVH Group （95.2±30. 2）min and the LAVH Group （90.2±30.7）min. The intraoperative blood loss was more in the TAH Group （139.3±7.8）ml than in the TVH Group （110±56.1）ml and the LAVH Group （100 ± 55.1）ml. The postoperative analgesic requirement rate was higher in the TAH Group （74.1%, 785 cases） than in the TVH Group （ 20.8% , 15 cases） and the LAVH Group （ 18.6%, 11 cases）. The length of postoperative hospitalization was longer in the TAH Group （12.1 ± 1.1）d than in the TVH Group （8.5±4.2）d and the LAVH Group （5.5±1.3）d. The postoperative pyrexia rates were not significantly different among the TAH Group （5. 9%, 63 cases） , the TVH Group （ 4. 2% , 3 cases） , and the LAVH Group （5.1% , 3cases）. [Conclusion]As compared with transabdominal hysterectomy, transvaginal hysterectomy and laparoscopic assisted vaginal hysterectomy show advantages of less invasion, less pain, and quicker recovery. Both of LAVH and TVH are minimally invasive surgery, but TVH fits the patients with little, prolapse uterus, and LAVH even fits those with appendix-cyst and large uterus.