不同术式全子宫切除术的临床效果比较

Comparison of clinical effect of total hysterectomy with different operative approach

目的:比较腹式、阴道式、腹腔镜、腹腔镜辅助阴道式全子宫切除术的临床效果。方法:527例全子宫切除术患者,其中经腹子宫全切除术(TAH)178例,阴道子宫全切除术(TVH)211例,腹腔镜全子宫切除术(LTH)51例,腹腔镜辅助阴道子宫全切除术(LAVH)87例进行回顾性研究,比较各组疾病种类、手术时间、出血量、术后病率、住院时间、医疗费用情况等。结果:平均手术时间,TAH组(102±25)min、TVH组(69±26)min、LTH组(156±48)min、LAVH组(114±33)min,TVH组平均手术时间与TAH、LTH、LAVH组相比,差异有统计学意义(P<0.05);出血量,TAH组(106±34)mL、TVH组(91±33)mL、LTH组(114±33)mL,LTH组出血量与TAH、TVH、LAVH组相比,差异有统计学意义(P<0.05);术后病率和排气时间,TAH组71%、(38±9)h,TVH组23%、(21±7)h,LTH组35%、(26±7)h,LAVH组29%、(24±8)h,TAH组与其他3组相比,差异有统计学意义(P<0.05);术后住院时间,TAH组(7.1±1.2)d、TVH组(5.1±1.5)d、TVH组(5.6±2.3)d、LAVH(5.3±1.9)d,TAH组显著长于其他3组,差异有统计学意义(P<0.05);医疗费用,TAH组(6 123±354)元、TVH组(7 261±286)元、LTH组(9 123±678)元、LAVH组(9 375±597)元,LTH、LAVH组医疗费用高于TAH、TVH组,差异有统计学意义(P<0.05)。结论:不同途径的全子宫切除术各有优势,微创外科及腔镜技术在今后的子宫切除术中占主导地位。

Objective：To compare the clinical effects of total hysterectomy with different operative approaches.Methods：To retrospectively analyze 527 cases of total hysterectomy,in which, 178 cases of transabdominal hysterectomy （TAH）,211 eases of transvaginal hysterectomy （TVH）,51 cases of laparoscopic total hystereetomy （LTH） and 87 cases of laparoseopy-assisted vaginal hysterectomy （LAVH）.The disease type,operative time, bleeding amount, postoperative morbidity,hospitalization time and medical cost were compared.Results ：The average operative time：（102±25）min in TAH, （69±26）rain in TVH, （156±48）rain in LTH and （114±33）min in LAVH. The average operative time between TVH and TAH, LTH, LAVH had statistical differenee（P〈0.05）.Bleeding amount： （106±34）mL in TAH, （91±33）mL in TVH, （114±33）mL in LTH. Bleeding amount of LTH had statistical difference compared with those of TAH,TVH and LAVH （P〈0.05）.The postoperative morbidity and exhausting time ：71%, （38±9）h in TAH,23%, （21±7）h in TVH,35%, （26±7）h in LTH,29%, （24±8）h in LAVH. The difference had statistical significance comparing TAH and the other 3 operative approaches （P〈0.05）. The hospitalization time：（7.1±1.2）d in TAH,（5.1±1.5）d in TVH,（5.6±2.3）d in LTH and （5.3±1.9）d in LAVH,the hospitalization time of TAH was longer than that of the other 3 groups with statistical difference（P〈0.05）. The medical eost：（6123±354）yuan in TAH, （7261±286） yuan in TVH,（9123±678）yuan in LTH and （9375±797）yuan in LAVH,the medical cost of LTH and LAVH was higher than that of TVH and TVH with statistical difference （P〈0.05）.Conclusion：Various operative approaches for total hysterectomy have their own superiority. Minimally invasive surgery and laparoscopic technique will occupy the dominant position in future.