腹腔镜辅助下经阴道子宫切除术子宫大小合理上限的探讨

Rational cutoff value of uterine size for laparoscopic assisted transvaginal hysterectomy

目的探讨腹腔镜辅助下经阴道子宫切除术(LAVH)子宫大小的合理上限。方法选择行LAVH手术976例,根据子宫大小分为四组:A组(子宫大小≤如孕8周,n=564)、B组(子宫增大如孕9～12周,n=324)、C组(子宫增大如孕13～16周,n=64)和D组(子宫增大如孕17～20周,n=24),比较各组手术时间、术中出血量、术后最高体温、肛门恢复排气时间和术后住院日。结果各组术后最高体温、肛门恢复排气时间和术后住院日比较,差异均无统计学意义(F分别=2.27、6.13、7.31,P均>0.05),而手术时间和术中出血量比较,差异均有统计学意义(F分别=32.14、21.54,P均<0.05)。D组手术时间和术中出血量明显高于A组、B组和C组三组,差异均有统计学意义(t分别=-53.67、-50.09、-43.95;-190.42、-143.90、-117.76,P均<0.05)。且Pearson相关分析结果显示:手术时间与子宫大小、术中出血量与子宫大小均存在正相关(r分别=0.20、0.21,P均<0.05)。结论子宫增大如孕16周或可为腹腔镜辅助下经阴道子宫切除术子宫大小的合理上限。

Objective To estimate a rational cutoff value of uterine size for laparoscopic assisted transvaginal hysterectomy. Methods A total of 976 patients received LAVH were divided into 4 groups according to their uterine size： group A （the uterus was not enlarged than 8 gestational weeks, n=564）, group B （the uterus was enlarged as 9- 12 gestational weeks, n=324）, group C （the uterus was enlarged as 13-16 gestational weeks, n=64） and group D （the uterus was enlarged as 17-20 gestational weeks, n=24）. The operative time, estimated blood loss, highest postoperative temperature, the time of anus regain to evacuate and duration of hospital stay were compared. Results The differences of highest postoperative temperature, the time of anus regain to evacuate and duration of hospital stay between the groups were not significant （F=2.27, 6.13, 7.31, P〉0.05 ）, whereas the differences of operative time and estimated blood loss were significant（F=32.14, 21.54, P〈0.05）. The operative time and estimated blood loss of group D were obviously more than those of the group A, B and C, and the differences were significant （t=-53.67,-50.09,- 43.95; -190.42, -143.90, -117.76, P〈0.05）. Positive correlations between uterine size and operative time and estimated blood loss could be found （r=0.20, 0.21,P〈0.05） Conclusions The rational cutoff value of uterine size for LAVH might be 16 gestational weeks.