3种微创子宫切除术的临床比较

Clinical comparative study of three kinds of minimal hysterectomy

目的：探讨3种微创子宫切除术式的安全性及优越性。方法：对1999年1月-2004年3月3种微创子宫切除术（108例腹腔镜下筋膜内子宫切除术、216例腹腔镜下全子宫切除术、184例非脱垂阴式子宫切除术）和296例腹式子宫切除术的患者进行回顾性分析。比较各组的手术时间、术中出血量、近期并发症和恢复情况等。结果：两种腹腔镜下子宫切除术的术中出血量、术后体温、肠道功能恢复时间、排气时间、恢复正常工作时间、住院天数、术后并发症发生率均明显少于腹式和阴式全子宫切除术组（P〈0．001或0．05），术后恢复正常工作时间和阴式子宫切除术组无明显差异（P〉0．05），但均明显少于腹式子宫切除术组。结论：3种微刨子宫切除术都是安全、可靠的术式，适于临床广泛应用，但要根据不同的病例特点和手术医生的经验选择不同的术式。

Objective： To investigate the safety and superiority of three kinds of minimal hysterectomy. Methods： 108 women undergoing classic intrafascial SEMM hysterectomy （CISH）, 216 women undergoing total laparoscopic hysterectomy （TLH） , 184 women un- dergoing transvaginal hysterectomy （TVH） for non- prolapse uterus and 296 women undergoing transabdominal hysterectomy （TAH） from January 1999 to March 2004 were studied retrospectively. The intraoperative time and postoperative blood loss, short term complieatlons and recovery of four groups were compared. Results： The intraoperative blood loss, hospital stay, the recovery time of peristalsis, time to full re- covery and the incidence of complications in TLH group and CISH group were less than those in TAH group and TVH group obviously （ P 〈 0. 05） . Time to tull recovery in TVH group was no different from that of TLH group and CISH group （P 〉0. 05） . Conclusion： TVH, TLH and CISH are safe, effeetive and reproducible procedures and can be performed widely, but different operation should be selected by the character different cases and the experience of operation doctors.