经腹、经阴道、腹腔镜全子宫切除术临床对比研究

Clinical comparative study of three patterns of hysterectomy

目的探讨经腹全子宫切除术(TAH)、非脱垂子宫经阴道全子宫切除术(TVH)、腹腔镜辅助阴式全子宫切除术(LAVH)的临床特点及临床价值。方法对上海市长宁区妇幼保健院2004年7月至2006年12月因子宫良性疾病需行子宫切除术的335例病例进行回顾性分析,其中TAH组118例、TVH组80例、LAVH137例,观察3组手术时间、术中出血情况、术后镇痛、术后病率和住院时间。结果LAVH组手术时间[(130·6±37·7)min]分别较TVH[(78·9±27·8)min]、TAH组[(88·1±32·4)min]延长(P<0·01),而后两者差异无统计学意义;LAVH组术后第1天血红蛋白下降[(9·3±7·6)g/L]分别显著高于TAH、TVH组(P<0·01),后两者差异无统计学意义;TAH组术后镇痛率(63·6%)分别显著高于TVH、LAVH组(P<0·05),后两者差异无统计学意义;住院时间TVH组[(6·4±1·8)d]与LAVH、TAH组差异有统计学意义(P<0·01)。3组术后病率比较差异无统计学意义(P>0·05)。结论TVH术式手术时间短、出血少,兼有TAH和LAVH的优点,子宫体积小于4个孕月时可采用该术式。临床应根据不同情况选择不同的子宫切除方式以达到最佳治疗效果。

Objective To compare the operative time, blood loss, hospitalization day, postoperative analgesic and postoperative morbidity in transabdominal hysterectomy（TAH）, transvaginal hysterectomy（TVH）, and laparoscopically assisted vaginal hysterectomy（LAVH）. Methods A total of 335 patients with benign uterine disease,who underwent TAH ,TVH or LAVH in Changning Maternal and Child Health Care Hospital from July 2004 to Dec. 2006,were retrospectively stud- ied （ 118 patients with TAH, 80 cases with TVH and 137 cases with LAVH ）. Results LAVH had significantly longer operative time[ （ 130. 6±37. 7）rain] than TAH and TVH [ （78.9 ±27. 8） rain, （88. 1 ±32. 4）mini （P 〈 0. 01 respectively）. Blood loss and haemoglobin decrease in LAVH group was significantly greater that those in TAH or TVH（P 〈 0. 01 respectively）. The postoperative analgesic rate in TAH was higher than those in TVH or in LAVH（P 〈 0. 05 respectively）. Hospital stay was significantly different among the abdominal vaginal and LAVH groups（P 〈0. 01 ）. The pyrexua rate was not significantly different in the 3 groups （P 〉 0. 05）. Conclusion TVH has shorter operating time,less blood loss,and the merits of TAH and LAVH. If the uterus size is less than that of four months pregnancy, TVH would be the choice. The keys to LAVH success include doctors skills and appropriate indications. It is reasonable to choose the pattern of hysterectomy according to the patients practical conditions.