三种子宫切除术的临床分析

Clinical analysis on three operative procedures of hysterectomy

目的:探讨3种子宫切除术的临床效果。方法:回顾分析为598例非脱垂式子宫疾病患者行不同途径子宫切除术的临床资料,其中腹腔镜鞘膜内子宫切除术(laparoscopic intrafascial supercervical hysterectomy,LISH)198例,腹腔镜辅助阴式子宫切除术(laparoscopic assisted vaginal hysterectomy,LAVH)200例,传统腹式全子宫切除术(total abdominal hysterectomy,TAH)200例,比较3组患者的手术时间、出血量、术中术后并发症、术后发热率、肛门排气时间、留置尿管时间、下床活动时间、术后住院时间、术后恢复满意性生活的例数及时间等。结果:平均手术时间LISH组显著短于LAVH组、TAH组(P<0.05)。术中平均出血量LAVH组最多,LISH组最少(P<0.05)。术后拔尿管时间、下床活动时间LISH组最短(P<0.05)。术中、术后主要并发症盆腔血肿LAVH组高于其他两组,TAH组切口延期愈合、肠梗阻发生率明显高于其他两组(P<0.05),无其他严重并发症发生。术后发热率TAH组显著高于其他两组(P<0.05)。术后肛门排气时间、住院时间TAH组明显长于其他两组(P<0.05),LISH组时间最短。3组患者均于术后3个月恢复性生活,LISH组绝大部分于术后4个月恢复术前性生活的感觉,明显早于其他组,差异有统计学意义(P<0.05)。结论:LISH组手术时间、出血量、下床活动时间、住院时间、恢复满意性生活时间等指标优于LVAH、TAH组。排除宫颈病变的患者行LISH是保留盆底结构完整,更安全可靠、干扰小、康复快的微创术式。

Objective：To investigate the clinical effects of three procedures of hysterectomy.Methods：Retrospective analysis was made on the clinical data of 598 patients with non-prolapsed uterus who underwent 3 different approaches of hysterectomy,including laparoscopic intrafascial supercervical hysterectomy（LISH,198 cases）,laparoscopic assisted vaginal hysterectomy（LAVH,200 cases）,and total abdominal hysterectomy（TAH,200 cases）.Operative time,blood loss,intraoperative and postoperative complications,postoperative fever rate,time of anal exhaust,detaining urinary canal,off-bed activity,postoperative hospital stay,cases and time of resumption of satisfactory sexual life of 3 groups were compared.Results：The average operative time of LISH was shorter than LAVH and TAH（P0.05）.The average volume of hemorrhage of LAVH was the highest,and LISH group was the least（P0.05）.The time of removal of urinary canal and off-bed activity of LISH was the shortest（P0.05）.The main complications,such as pelvic hematoma incidence rate was the highest in LAVH,while the incidence rate of delayed healing of incision and intestinal obstruction in LAH group was higher than that of other 2 groups（P0.05）.The incidence of fever in TAH was the highest（P0.05）.The time of farting and the hospital stay of LISH was the shortest,TAH was the longest（P0.05）.All the patients recovered sexual life in the 3rd month after operation,and most of the LISH patients were satisfied with sexual life in 4 months after operations,earlier than other groups（P0.05）.Conclusions：LISH is better than LVAH and TAH in operative time,blood loss,off-bed activity time,hospital stay and resumption of satisfied sexual life.For patients excluded cervix diseases,LISH can keep the integrity of the pelvis,and it is a safe,reliable and minimally invasive operation with quick recovery.