腹腔镜辅助阴式与经阴切除非脱垂大子宫的临床研究

Clinical study of Laparoscopically assisted vaginal hysterectomy and Transvaginal hysterectomy for treatment of large non-prolapsed uterus

目的比较非脱垂大子宫（大于14孕周）在腹腔镜辅助下阴式、经阴全子宫切除两种微创手术方法的临床疗效，探讨切除非脱垂大子宫的术式特点及选择原则的可靠性及安全性。方法回顾2000年1月～2010年4月，对〉14孕周的良性非脱垂子宫的病变患者分别采用腹腔镜辅助阴式子宫切除术（LAVH）171例，经阴道全子宫切除（TVH）195例完整临床资料进行对比分析。结果LAVH、TVH在术中出血量、术后病痛、术后排气、住院时间比较差异无统计学意义（P〉0．05），但在术前手术史、盆腔黏连等情况，术中、术后并发症、中转开腹几率有显著差异（P〈0．05）。结论通过腹腔镜辅助手术可清楚地观察盆腹腔脏器情况，有效地提高阴式手术的成功率和安全性。临床中应据情况选择需要的手术方式，以达到最佳治疗效果。

Objective To compare the clinical relevant outcomes between Laparoscopically assisted vaginal hysterectomy（LAVH） and Transvaginal hysterectomy （TVH） for large non-prolapsed uterus, explore the reliability and safety of the surgical characteristics and selection principle about the resection the large non-prolapsed uterus. Methods A retrospective analysis of 366 cases of vaginal surgery was performed between January 2000 and April 2010 in General Hospital of Chinese People＇ s Armed Police Forces. All patients were benign non-prolapsed lesions uterus more than 14 weeks gestation. 171 cases were used to Laparoscopically assisted vaginal hysterectomy, and 195 cases were used to Transvaginal hysterectomy. Results There were no significant differences in blood loss, postoperative pain, postoperative discharge, length of hospital stay in bath LAVH and TVH （P〉 0.05）, but there were significant differences between LAVH and TVH in the preoperative surgery, pelvic adhesions, the intraoperative , postoperative complications, conversion to open （P〈0.05）. Conclusion The use of the unique advantages of laparoscopic assisted by laparoscopy could clearly observe the abdominal Organs; effectively improve the success and clinical outcomes of vaginal surgery. Surgical method should be considered according to clinical situation to achieve the best therapeutic effect.