非脱垂瘢痕子宫经阴道切除术107例临床分析

Clinical Analysis of 107 Cases of Transvaginal Hysterectomy for Cicatricial Non-Prolapsed Uterus

目的:探讨瘢痕子宫经阴道切除术的可行性、手术方法和经验。方法:回顾性分析我院2004年1月至2009年5月间,107例瘢痕子宫阴式切除术患者(研究组),100例瘢痕子宫腹式切除术患者(对照组Ⅰ),以及同期100例无盆腔手术史非脱垂子宫阴式切除术患者(对照组Ⅱ)的临床资料,并进行对比研究。结果:三组患者年龄、子宫大小及盆腔基础疾病分布差异无显著性。研究组患者平均手术时间、平均术中出血量均低于对照组Ⅰ(分别为62 min,110 ml与101 min,150 ml),差异有统计学意义(P<0.01);研究组术后肛门排气时间、下床活动时间、住院时间短于对照组Ⅰ(P<0.01),与对照组Ⅱ相比差异无显著性(P>0.05);术后发热率较对照组Ⅰ减少(4.7%与13.0%),术后阴道残端异常发生率3组差异无显著性(P>0.05)。结论:非脱垂的瘢痕子宫经阴道切除术与腹式切除术相比,手术时间短,创伤小,住院时间少,并发症发生率低,但需掌握一定的手术技巧。

Objective： To assess the feasibility,technique and experience of transvaginal hysterectomy for cicatricial non-prolapsed uterus.Methods： The clinical data of 107 cases of cicatricial non-prolapsed uterus underwent transvaginal hysterectomy were compared with those of two control groups： groupⅠ（100 cases of transabdominal hysterectomy for cicatricial non-prolapsed uterus）,and group Ⅱ（100 cases of transvaginal hysterectomy for non-prolapsed uterus with no previous operations）.Results： There were no significant differences in patient age,the volume of uterus,and uterus diseases distribution among the three groups.Compared with the control group Ⅰ,the study group had a significant reduction in operation time and the average volume of blood loss（62.7 min vs 101.1 min,110.1 ml vs 150.5 ml,respectively,both P0.01）.The postoperative hospital stay,the time to first flatus and to ambulation were less（all P0.01）,and the incidence of postoperative complications（fever or infection） was decreased in the study group（4.7% vs 13.0%）.There were no significant differences in complications of the vaginal remnants among the three groups（P0.05）.Conclusion： Transvaginal hysterectomy has advantages in less damage,reduced operative time,less hospital stay and complications as compared with the abdominal route operation,but the operators should be skillful in surgical techniques.