阴式子宫切除术50例临床分析

Clinical Analysis of 50 Cases of Transvaginal Hysterectomy

目的 探讨阴式子宫切除术（ＴＶＨ） 的优点、适应证、手术要点及临床应用价值。方法 自１９９５ 年１０ 月至１９９８ 年１１ 月，对５０ 例因多发性子宫肌瘤、子宫腺肌病、宫颈原位癌、功能失调性子宫出血及子宫内膜不典型增生而无生殖道脱垂患者，行ＴＶＨ。术前子宫大小正常者１０ 例（２０％ ） ，子宫＞１２ 周者（ 大子宫）１６ 例（３２ ％） ，子宫增大但≤１２ 周者２４ 例（４８％ ）。既往有手术史者６ 例（１２％ ）。同时行附件切除术者１１ 例（２２％ ）。术中同时采用锥形、环形切开子宫松解法、楔形分碎子宫法、子宫对半切开法及子宫肌瘤剥出法处理大子宫。５０ 例中７ 例（１４％ ） 在腹腔镜辅助下行卵巢囊肿剥除、附件切除或盆腔粘连分解术后再行ＴＶＨ。结果 手术时间４０ ～１１０ 分钟，平均６３ 分钟；出血量５０ ～１００ ｍｌ；住院时间２ ～８ 天，平均４ 天；术后止痛药使用次数０～３ 次，平均１ 次；仅１ 例术后残端出现小血肿，经保守治疗后痊愈。结论 ＴＶＨ 手术时间短、出血量少、腹部无瘢痕、切口疼痛轻、康复迅速。对子宫＞１２ 周，输卵管、卵巢有良性病变以及既往有盆腔手术史者，并非ＴＶＨ 的禁忌证。

Objective To assessthe advantage,indications,surgical management andthe clinicalvalue oftransvaginal hysterectomyin patients without uterine prolapse. Methods From Oct.1995 to Nov.1998 ,50 women undergonetransvaginalhysterectomyforvariousbenign gynecologicallesions were consecutivelyincludedin thisstudy.Their mean age was 45 years (range 36 ～50) .There were 10 patients (20% ) with normal uterine size,and 16 (32 %) with uteriof > 12 gestational weeksize (range 14～16 weeks) andtheremaining 24(48 %) ≤12 weeksize.11 patients (22% ) underwent salpingo oophorectomy simultaneously,6 patients (12% ) had previouslaparotomy. Results The mean operating time was 63 min with a range 40 110 min.Post operative hospitalstay averaged 4 days(range2 ～8 dyas).Theamountofbloodloss during operationranged 50 ～100 ml. The only postoperative complication wassmallresidue hematomain 1 case and cured with conservativetreatment. Conclusions Transvaginal hysterectomy was associated with remarkable advantages:shorter operating time and hospitalstay,fewercomplication,lessdiscomfort,quickerrecoveryandlessexpenses.Enlarged uterustoasize of > 12 gestational weeks; benign adnexal mass or previous operation should no longer be considered as contraindication oftransvaginalhysterctomy.