非脱垂阴式全子宫切除术的临床研究

The Exploration on the Practicability Value of Trans-Vaginal Hysterectomy.

目的探讨非脱垂阴式子宫切除术的临床应用价值。方法以2004年1月至2007年1月本院收治的有子宫切除指征的患者136例为研究对象[年龄为45～64岁,孕、产次为(2.85±1.03)次、(2.32±1.12)次],按患者意愿将其分为两组(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准,得到该委员会批准,分组取得受试对象的知情同意,并与患者签署临床研究知情同意书),分别采取阴式全子宫切除术(trans-vaginal hysterectomy,TVH)和腹式全子宫切除术(trans-abdominal hysterectomy,TAH)。阴式全子宫切除术组(TVH组,n=60)采用阴式子宫切除术,其中子宫体积≤10孕周为43例,10～14孕周为17例;有下腹部手术史为15例。腹式全子宫切除术组(TAH组,n=86),采用腹式子宫切除术,其中子宫体积≤10孕周为65例,10～14孕周为21例;有下腹部手术史为20例。两组患者年龄,孕、产次子宫大小,有无下腹部手术史等比较,差异无显著意义。观察、比较两组的手术持续时间、术中出血量、术中并发症、术后肛门排气时间、术后下床活动时间、住院时间、切口感染率等。结果TVH组手术持续时间较TAH组明显缩短,差异有显著意义(t=-5.11,P<0.01);TVH组术中出血量较少,两组比较,差异有显著意义(t=-3.08,P<0.05)。术后TVH组肛门排气时间早、下床活动时间快、切口感染率较低,两组比较,差异有显著意义(t=-2.34,P<0.05;t=-4.52,P<0.01;χ2=-2.30,P<0.05);两组住院费用比较,差异无显著意义。两组均无手术并发症发生,手术顺利。结论阴式全子宫切除术术中、术后患者情况均优于腹式全子宫切除术,是全子宫切除较好的微创术式。

Objective To explore the clinic value of trans-vaginal hysterectomy. Methods From January 2004 to January 2007, 136 hospitalized patients with signs of hysterectomy were divided into trans-vaginal hysterectomy group （TVH group, n = 60） and t rans-abdominal hysterectomy group （TAH group, n= 86） according to their choices. Informed consent were obtained from all patients. Sixty cases in the TVH group were all received trans-vaginal hysterectomy, including 43 cases with uterine volume lower than 10 gestational weeks, and 17 cases during 10-14 gestational weeks; and 15 case had operation history. Eighty-six cases in the TAH group were all received trans-abdominal hysterectomy, including 65 cases with uterine volume lower than 10 gestational weeks, and 21 case during 10- 14 gestational weeks; and 20 cases had operation history. The following items were compared between two groups, operative duration, blood loss, intraoperative complication, post-surgery anal-exsufflation time, postoperative activity out of bed days, hospitalization time and rate of wound infection. Results In terms of the operative duration and intraoperative blood loss, the TVH group were significantly lower than those in the TAH group（t=-5.11, P〈0.01; t=-0.38, P〈0.05）. Furthermore, compared with the items of post surgery anal-exsufflation time, postoperative activity out of bed days, and wound infection rate, two groups had significant differences（t= -2.34, P〈0. 05; t= -2.30, P〈0. 05; χ^2= -2.30, P〈0. 05）. There had no significant difference of hospitalization expenses between two groups. All the operations were smoothly completed without any complication. Conclusion The trans vaginal hysterectomy is an applicable minimal invasive operative method, which has better effects than trans-abdominal hysterectomy.