阴式和改良后腹式大子宫切除临床效果分析

Clinical study of the operation procedures for trans-vaginal hysterectomy and modified total abdomino hysterectomy with large uterus

目的探讨经阴道子宫全切术(trans-vaginal hysterectomy,TVH)和经腹子宫全切术(traditional totalabdomino hysterectomy,TTAH)及其改良后经腹子宫全切术(modified total abdomino hysterectomy,MTAH)在大子宫切除中的临床效果。方法回顾性分析82例大子宫切除的临床病例记录,包括手术时间、术中出血量、抗生素使用时间、并发症发生率、肛门排气时间、住院天数、住院费用,比较各组术中和术后情况。结果肛门排气时间、抗生素使用时间、住院天数和住院费用TVH<MTAH<TTAH组(P<0.05),手术时间、术中出血量和并发症发生率三者无统计学意义(P>0.05)。结论对于大于12孕周的子宫三种手术方式各有优势,且不可互相替代,结合患者情况,医院的医疗条件和技术水平等综合考虑,尽量选择微创和经济的手术方式。

Objective To investigate the clinical result of trans - vaginal hysterectomy, traditional total abdomian hysterectomy and modified total abdomino hysterectomy for large uterus hysterectomy. Methods Retrospectively,analysis the clinical records of 82 cases for large uterus hysterectomy, including operation time, bleeding volume, antibiotic administration time, the rates of complications occurred, bowel function recovery time, hospital - duration and hospital - cost, and the pro - operation and post- operation effects were compared. Results The bowel function recovery time, antibiotic administration time,hospital -duration and hospital -cost in TTAH group was higher than that the other two groups,the TVH group showed the lowest in the three groups （ P 〈 0.05 ）. While the operation time, bleeding volume and the rates of complications occurred groups had no significant difference （ P 〉 0.05 ）. Conclusion Three different operation procedures for total hysterectomy with more than 12 fetation week uterus have their own advantages and disadvantages, Considering the conditions of patients, hospital and technical level, a microinvasive and economical surgery should be chosen.