不同术式全子宫切除临床分析

Clinical effect of different methods of total hysterectomy

目的分析因子宫良性疾病行经阴道全子宫切除术(VH)、腹腔镜下全子宫切除术(TLH)和经腹全子宫切除术(TAH)的临床效果。探讨各种术式的优缺点,寻找更合理的适应证。方法将有全子宫切除指征的经阴道全子宫切除术(VH)41例患者、腹腔镜下全子宫切除术(TLH)43例患者和经腹全子宫切除术(TAH)42例患者的临床资料进行回顾分析。比较3种术式的手术时间、术中出血量、术后排气时间、术后住院时间等情况。结果手术时间:VH组(67.32±14.79)min、TLH组(91.98±15.28)min和TAH组(94.17±20.57)min。术中出血量:VH组(69.05±32.36)mL、TLH组(67.21±32.90)mL和TAH组(100.24±39.23)mL。术后肛门排气时间:VH组(20.51±5.92)h、TLH组(19.84±4.95)h和TAH组(41.26±5.86)h。术后住院日:VH组(5.71±1.42)d、TLH组(5.58±1.33)d和TAH组(7.31±1.09)d。在手术时间方面:VH组平均手术时间显著短于TLH组及TAH组,差异均有显著性,TLH组与TAH组比较,差异无显著性。在术中出血量、术后肛门排气及术后住院日数方面:VH、TLH组与TAH组比较差异有显著性,VH和TLH两组比较,差异无显著性。结论VH、TLH符合微创手术原则,具有术中出血少、对患者内环境干扰少、术后恢复快、术后住院时间短的优点,值得临床推广。

[ Objective ] To evaluate and compare the clinical efficacy of vaginal hysterectomy （VH）, total laparoscopic hysterectomy （TLH） and total abdominal hysterectomy （TAH）. [ Methods ] A retrospective analysis was made on clinical data of 41 cases of VH （vaginal group）, 43 cases of TLH （laparoscopic group） and 42 cases of TAH （open group）.The operating time, blood loss, time for first passing flatus and duration of hospitalization were respectively compared between these three groups. [Results] Patients in VH and TLH groups presented significantly less blood loss [（69.05±32.36） mL and （67.21±32.90） mL] than that in TAH group [（100.24±39.23） mL], and the time of VH and TLH groups for first passing of flatus [（20.51±5.92） h and（19.84±4.95） h ] was significantly shorter than that of TAH group [（41.26±5.86） h], and the duration of hospitalization in VH and TLH groups [5.71±1.42） d and （5.58±1.33） d] was significantly shorter than that of TAH [（7.31±1.09） d], operating time of VH [（67.32±14.79） mini was significantly shorter than those of TLH and TAH [（91.98±15.28） min and （94.17±20.57） min]. [ Conclusion] Vaginal hysterectomy and total laparoscopic hysterectomy are two kinds of safe and effective operation. They offer little blood loss, little interference to abdominal organs, and quick postoperative recovery.