腹腔镜辅助下阴式全子宫切除与开腹全子宫切除术的临床效果比较

Clinical Comparison on Laparoscopically Assisted Vaginal Hysterectomy versus Total Abdominal Hysterectomy for Non-prolapsed Uteri

目的:比较腹腔镜辅助阴式子宫切除术(LAVH)与经腹子宫切除术(TAH)的临床效果。方法:2003年12月—2008年3月间648例妇科良性疾病非子宫脱垂患者行全子宫切除术,其中开腹组602例和腹腔镜辅助阴道全子宫切除组46例回顾分析两组患者的临床情况。结果:两组患者在年龄、孕次、既往腹部手术次数、其他系统合并症、体质量指数(BMI)方面差异无统计学意义(P>0.05)。TAH组产次少于LAVH组,差异有统计学意义(P=0.027)。两组的妇科疾病种类构成比差异有统计学意义(P<0.05)。TAH组比LAVH组手术时间短(P<0.05)、出血比LVAH组少(P<0.05),血红蛋白下降值比LAVH组少,但两组间差异无统计学意义(P>0.05)。TAH组比LAVH组术后住院时间长(P<0.05)、术后恢复正常排便时间长(P<0.05),术后3d内最高体温TAH组稍高,但两组间差异无统计学意义(P>0.05)。切除的子宫原位置两组间差异无统计学意义(P>0.05),但TAH组切除的子宫更大(P<0.05)。LAVH组中转开腹率为4.3%。LAVH组并发症发生率为6.5%(3/46),TAH组并发症发生率10.6%(64/602),两组之间差异无统计学意义(P>0.05)。结论:腹腔镜辅助阴式子宫切除术具有创伤小、恢复快、住院时间短等优点,但在手术时间等方面仍存在不足。

Objective： To compare the clinical characteristics and efficacy between total abdominal hysterectomy（TAH） and laparoscopieally assisted vaginal hysterectomy（LAVH）. Methods：A retrospective analysis was made on chinical data of 602 cases of TAH group and 46 cases of LAVH group from December 2003 to March 2008,excluding malignancy and cases with prolapsed uteri. Results： There were no statistically significant differences between the two groups on age, gravidity, past abdominal operation hystories, other systematically disease and body mass index（P〉0.05） Gynecological disease constituent ratio remarkably differed in two groups（ P = 0. 000）. Parity, operating time and blood loss during operation were statistically prominently less in TAH group（P〈0.05） while hemachrome degression was also less without markedly difference（P = 0. 058）. TAH cuts larger size of uteri（P = 0. 002） without signifantly difference in location（P = 0. 926）. The ratio of LAVH turning to open operation was 4.3%. LAVH gives shorter hospital stay（P = 0. 002）, quicker first defecation（P = 0. 045）, lower temperature peak（P = 0. 318） and less complication incidence rate during or after operation（P = 0. 455）. But the latter two were not strikingly different（P〉0.05）. The total sample complication incidence rate was 10.3 % （67/648）. Group total complication in cidence rate was 6.5 % （3/46）in LAVH provides and 10.6% （64/602） for TAH group. Conclusion： LAVH gives less damage, quicker recovery and shorter hospital stay while existing disadvantages in some directions.