非脱垂子宫阴式切除术临床应用价值

A discussion on the influence factors of transvaginal hysterectomy of non-prolapsed uterus.

目的探讨非脱垂子宫阴式切除术的临床价值。方法2005年9月至2007年9月在中国医科大学附属盛京医院,将阴式子宫切除术(TVH)420例作为观察组,经腹子宫切除术(TAH)100例作为对照组1,观察手术时间、出血量及术后情况。结果TVH组手术成功率为99.52%,膀胱、直肠副损伤发生率为0.002%。TVH组与TAH组比较,手术时间分别为(59.73±18.70)min,(61.21±15.97)min;出血量分别为(82.31±25.33)mL,(76.54±27.33)mL,P>0.05。术后病率、肠功能恢复时间、术后平均住院日,TVH组分别为5.5%、(31.87±5.56)h、(3.89±1.68)d;TAH组分别为19.0%、(55.45±8.97)h、(5.66±2.12)d,P均<0.05;术后阴道炎性息肉发生率,TVH组(9.33%)高于TAH组(5.00%),P<0.05。TVH组以无影响因素病例为对照组2,手术时间为(50.70±16.37)min,出血量为(71.33±25.00)mL;有影响因素各组手术时间和出血量分别为:子宫≥妊娠12周组为(66.86±18.17)min及(79.75±37.81)mL;最大肌瘤直径≥9cm组为(86.00±12.31)min及(98.00±16.73)mL;盆腔粘连组为(62.08±11.60)min及(90.00±25.02)mL;P均<0.05。而剖宫产术后组为(54.09±13.70)min及(70.68±18.64)mL;合并附件肿物组为(51.29±14.92)min及(73.23±14.69)mL;P均>0.05。结论非脱垂子宫行阴式切除术创伤小,手术安全可靠。

Objective To discuss the influence factors of transvaginal hysterectomy of non-prolapsed uterus. Methods From September 2005 to September 2007, 420 cases who underwent transvaginal hysterectomy （ TVH）, were chosen as study group, 100 cases who underwent transabdominal hysterectomy （TAH） ,were chosen as control group in Shengjing Hospital of China Medical University. The operating time, blood loss and postoperative condition of patients were evaluated between the groups. Results The operation success rate of TVH group was 99. 52% ,bladder and rectum complication incidence rate was 0. 002%. Comparing TVH group and TAH group,the operating time was （59. 73 ± 18. 70）min, （61.21± 15.97） min, respectively; the blood loss was （ 82. 31± 25.33 ） mL, （76. 54 ± 27.33 ） mL, respectively, appeared no difference, P 〉 0. 05. The postoperative febrile morbidity, bowel movement recovery time, length of postoperative hospital stay of TVH group were 5.50%, （31.87 ± 5.56） h, （3.89 ± 1.68） d; and those of TAH group were 19.00%, （55.45± 8. 97 ） hr, （ 5.66 ± 2. 12 ） day, all P 〈 0. 05 ; post-operative vaginal inflammatory polypus incidence rate of TVH group （9. 33% ） was higher than that of TAH group（5.00% ） ,P 〈0. 05. In TVH group,we chose the cases without influence factors as intragroup control, the operative time was （50. 70 ± 16. 37 ）min, blood loss was （71.33 ± 25.00 ） mL;those of the group of uteri ≥ 12 weeks of gestation were （66. 86 ± 18. 17 ） min and （79.75 ± 37.81 ） mL;those of the largest fibroid diameter ≥9cm group were （86. 00± 12.31 ） min and （ 98. 00± 16. 73 ） mL; and those of adhesion group were （62. 08 ± 11.60） min and （90. 00 ±25.02）mL;all P 〈0. 05. The operating time and blood loss of post cesarean section group were （ 54.09 ±13.70 ） min and （ 70. 68 ± 18.64 ） mL ; those of complicating adnexal mass group were （51.29 ± 14. 92 ） min and （ 73.23 ± 14. 69 ） mL; all P 〉 0. 05. Conclusion The transvaginal hysterectomy of non-prolapsed uterus performed less trauma and was safe and validity.