大子宫经阴道切除25例临床分析

Clinical Study on Transvaginal Hysterectomy for Moderate Enlarged Uterus

就子宫切除的两种途径而言，经阴道子宫切除术（ Ｔ Ｖ Ｈ） 比经腹部子宫切除术（ Ｔ Ａ Ｈ） 早开始５０ 年。虽然 Ｔ Ｖ Ｈ 有比 Ｔ Ａ Ｈ 对病人创伤小、恢复快、无体表瘢痕等优点，但在临床应用中，绝大多数医院只限于对子宫脱垂者行 Ｔ Ｖ Ｈ。其主要原因是由于 Ｔ Ｖ Ｈ 的适应证、禁忌证较难掌握；医生缺乏 Ｔ Ｖ Ｈ 的手术经验；病人对手术方式的选择缺乏认识。近１０ 年来，由于腹腔镜辅助的经阴道子宫切除术（ Ｌ Ａ Ｖ Ｈ） 的开展，进行部分的和完全的 Ｔ Ｖ Ｈ 机会越来越多。随着 Ｔ Ｖ Ｈ 技术的熟练，近几年国内对 Ｔ Ｖ Ｈ 应用增多，尤其对大子宫的 Ｔ Ｖ Ｈ 应用，有较成熟的经验。鲁永鲜等和刘珠凤等的两篇论文对大子宫的 Ｔ Ｖ Ｈ 方法及优点作了全面分析，供临床应用参考。但对经验不足的医生，应谨慎从事，由易到难，循序渐进，注意适应证的选择，减少和避免手术时间长、出血多、膀胱和直肠损伤等副作用的发生。 【摘要】 目的 探讨大子宫经阴道切除的安全性和可行性。方法 采用子宫劈开、肌核剜除、碎解等缩小子宫体积的方法，对２５ 例子宫增大如１２ ～１７ 孕周［ 平均（１４ ．０ ±１ ．７） 周］ 、重２８０ ～５７０ ｇ［ 平均（３７２ ±７４）ｇ］ 的子宫肌瘤?

Objective To assess the feasibility and safety of performing transvaginal hysterectomy(TVH) on moderate enlarged uteri. Methods Twenty five transvaginal hysterectomies were performed on enlarged myomatous uteri,with the size equivalent to 12～17 gestational week or 280～570g. Bisection, enucleation, morcellation and combinations thereof were used to facilitate the operation by reducing the uterine volume. The operation time, blood loss, morbidity as well as complications were observed and analyzed. Results Twenty two out of 25 vaginal hysterectomies were successfully completed with a success rate of 88%. Another 3 cases were converted to transabdominal hysterectomies, 2 of them were due to technical difficulties. One bladder injury and one severe intraoperative hemorrhage occurred. Two cases required blood transfusion. The mean operating time was (119±32 )min. The mean blood loss was (231±107)ml with a range of 100～500 ml except the case with severe hemorrhage. The morbidity rate was as low as 4% and the average postoperative hospital stay was (5.5±1.1) days. The follow up at 2～48 months after operation showed excellent recovery in all cases without any late postoperative complications. Conclusion In the hands of experienced vaginal operation surgeons some of the enlarged uteri(≥12 weeks gestational size, i.e≥280 g) with benign disease can be safely removed transvaginally through reduction of uterine volume if the uterus is mobile and obtaind more satisfactory recovery.