全子宫切除术三种术式的比较研究

Comparative Study of Three Operations for Complete Hysterectomy

目的分析比较开腹子宫切除术(TAH)、阴式子宫切除术(VH)和腹腔镜辅助下阴式子宫切除术(LAVH)三种全子宫切除术的手术方法、适应证、术后疗效及临床应用价值.方法选取2000年1月至2010年1月因子宫肌瘤、子宫腺肌症、顽固性功血等指征在施行的139例全子宫切除术患者,开腹子宫切除术47例、阴式子宫切除术48例、腹腔镜辅助下阴式子宫切除术44例共139例的临床资料进行分析,比较三组术中、术后情况.结果腹腔镜手术组与开腹手术组及阴式手术组比较有术后发病率低、肛门排气及下床活动时间早、住院时间短、术后疼痛轻微、恢复良好等优点,两者差异有统计学意义(P<0.05).结论腹腔镜辅助阴式子宫切除术较开腹子宫切除术和阴式子宫切除术更具有创伤小,术后恢复快及住院时间短等优点,扩大了阴式手术的适应证和弥补了手术的不足,值得推广.

Objective To compare the operation ways,indications,therapeutic effects,and clinical application values among trans-abdominal hysterectomy（TAH）,vaginal hysterectomy（VH）,and laparoscopically assisted vaginal hysterectomy（LAVH）.Methods We analyzed the clinical data of 139 patients who received complete hysterectomy because of hysteromyoma,adenomyosis,or refractory dysfunctional uterine bleeding in our hospital from January 2000 to January 2010.The 139 cases of complete hysterectomy included 47 cases of TAH（TAH group）,48 cases of VH（VH group）,and 44 cases of LAVH（LAVH group）.We compared the data of patients among the three groups.Result Compared with TAH group and VH group,patients in LAVH group had lower incidence rate,earlier passage of gas by anus and out-of-bed activity,shorter stay in hospital,slighter postoperative pain,and better recovery,the difference had statistical significance（P0.05）.Conclusion Compared with trans-abdominal hysterectomy（TAH）and vaginal hysterectomy（VH）,laparoscopically assisted vaginal hysterectomy（LAVH）has less trauma,sooner recovery,and shorter stay in hospital,it also broadens the indications of VH,and overcomes the disadvantages of VH,therefore deserve to generalize in clinic.