腹腔镜辅助与阴式大子宫切除的比较性研究

A Comparative Study on Laparoscopic-Assisted Vaginal Hysterectomy and Vaginal Hysterectomy

目的 探讨腹腔镜辅助阴式大子宫切除的临床应用价值. 方法 2005年1月～2007年3月,我院行大子宫（子宫如孕10～18周）切除94例,其中腹腔镜辅助阴式全子宫切除（laparoscopic-assisted vaginal hysterectomy,LAVH）56例,阴式子宫切除术（vaginal hysterectomy,VH）38例,比较两种方式手术时间、出血量、术后住院天数、并发症的发生率. 结果与VH组相比,LAVH组中转开腹率低（0/56 vs 5/38, χ^2=5.389,P=0.020）,手术时间短[（149±11） min vs （179±14） min,t=-11.610,P=0.000],术后住院时间短[（5.8±1.4）d vs （7.3±3.6） d,t=-2.825,P=0.006].两组术中出血量、术后病率、术后排气时间差异无显著性（P＞0.05）. 结论 LAVH扩大VH的适应证,使大于孕10周子宫切除能在微创手术下顺利完成,是值得推广的手术方法.

Objective To explore the clinical value of laparoscopic-assisted vaginal hysterectomy（LAVH） in large uterus. Methods Retrospective analysis was conducted on clinical data of 94 patients（ whose uterus were as big as 10 - 18 gestational weeks） who received hysterectomy from January 2005 to March 2007, in which 56 cases were performed laparoscopic-assisted vaginal hysterectomy （LAVH group） and 38 cases vaginal hysterectomy （VH group）. The operation time, blood loss, postoperative hospital stay, and the incidence of postoperative complications were compared between the two groups. Results Compared with VH group, there were a lower chance of abdominal hysterectomy（0/56 vs 5/38, χ^2 = 5. 389, P = 0. 020）, a shorter operation time [ （ 149 ± 11 ） minvs （179 ±14） min, t= -11.610, P=0.000] and ashorter postoperative hospital stay [（5.8±1.4）d vs （7.3 ±3.6） d,t= -2. 825, P = 0. 006 ] in the LAVH group. There were no significant differences in blood loss, morbidity and time to first flatus between the two groups. Conclusions The LAVH extends the indications of VH, ensuring the safety of VH for the uterus bigger than 10 gestational weeks, therefore it is an operative procedure to be recommended.