三种腹腔镜全子宫切除术术式比较

Comparison of Three Subcategories of Laparoscopic Hysterectomy

目的 比较性研究3种腹腔镜全子宫切除术：完全腹腔镜全子宫切除术（TLH）和两种腹腔镜辅助阴式全子宫切除术（LAVH）的特点。方法 回顾性分析了2002年9月-2005年9月间在我院行腹腔镜全子宫切除术393例患者的临床资料，其中TLH178例，LAVHa177例，LAVHb38例。结果 各组均以子宫肌瘤、子宫腺肌症为最常见病因，在TLH组、LAVHa组和LAVHb组分别占66．9％、38．4％和52．6％。TLH组在平均手术时间和出血量上与LAVHa组相比差异无显著性（P〉0．05），但较LAVHb组少（P〈0．05）；TLH组切除子宫的体积显著大于其他两组（P〈0．05）。手术并发症发生率在TLH组为9．0％，低于LAVHa组（14．1％）和LAVHb组（18．4％），但无统计学差异（P〉0．05）。结论 TLH组切除的子宫体积较大，不影响出血量和手术时间，且并发症较少。

Objective To compare the clinical characteristics of three subcategories of laparoscopic hysterectomy： total laparoscopic hysterectomy （TLH） and two subcategories of laparoscopic-assisted vaginal hysterectomy （LAVH） ： LAVHs and LAVHb. Methods We retrospectively analyzed the clinical data of 393 patients underwent laparoscopic hysterectomy, including TLH （ n = 178 ）, LAVHa （ n = 177 ）, and LAVHb （ n = 38）, in our hospital from September 2002 to September 2005. Results Myoma and adenomyosis of uterus were the most common diseases in this study, accounting for 66. 9% , 38.4% , and 52.6% in TLH group, LAVHa group, and LAVHb group, respectively. The mean surgery duration and blood loss were not significantly different between TLH group and LAVHa group （ P 〉 0.05 ）, but were significantly less in TLH group than in LAVHb group （ P 〈 0.05 ）. The bulk of uterus in TLH group was significantly bigger than in other two groups （P 〈 0.05 ）. The incidence of major complications in the TLH group （9.0%） was lower than in LAVHa group （ 14. 1% ） and in LAVHb group （ 18.4% ）, but without statistical significance. Conclusion Compared with LAVH, TLH is feasible to deal with bigger uterus with less blood loss and shorter surgery duration and without more frequent complications.