改良腹腔镜辅助下阴式子宫切除术临床分析

Clinical analysis of modified laparoscope assisted vaginal hysterectomy

目的探讨改良腹腔镜辅助下阴式子宫切除术的临床效果。方法回顾性分析腹腔镜辅助下阴式子宫切除术(LAVH)50例和改良LAVH 50例,包括手术时间、术中出血量、术中并发症(输尿管、膀胱和直肠损伤)、阴道残端出血及术后住院日。结果与LAVH比较,改良LAVH剪断而不结扎骶主韧带、使用百克钳代替传统双极电凝、将盆底腹膜和阴道黏膜做两个半荷包缝合关闭阴道残端,手术时间LAVH(69.00±15.10)min,改良LAVH(43.20±11.58)min;术中出血量LAVH(230.00±65.4)mL,改良LAVH(180.56±58.3)mL;术中并发症LAVH 4例,改良LAVH 1例;阴道残端出血LAVH 7例,改良LAVH 2例;术后住院时间LAVH(6.5±2.5)d,改良LAVH(6.4±3.0)d。两组比较,手术时间及术中出血量改良LAVH明显少于LAVH,两者均有显著性差异(P<0.01);术中并发症改良LAVH少于LAVH,术后住院日差异无显著性(P>0.01)。结论改良LAVH具有手术时间短、出血少、损伤小的优点。

Objective To explore the clinical efficacy of modified laparoscopic-assisted vaginal hysterectomy（LAVH）.Methods The clinical data of 50 patients who received LAVH and 50 patients who received modified LAVH were retrospectively analyzed,including surgical duration,intraoperative blood loss,intraoperative complications（ureteral,bladder and rectal injuries）,vaginal stump bleeding and postoperative hospital stay.Results Compared with the LAVH group,the modified LAVH group only had a cutting of the sacroiliac ligament instead of having a ligation.Biclamp forceps was employed to replace traditional electronic coagulation equipment.The pelvic floor peritoneum and vaginal mucosa were made into two half-pouches and sutured,thus closing vaginal vault.The mean surgery duration in the LAVH group was（69.00±15.10） min and（43.20±11.58） min in the modified LAVH group.The intraoperative blood loss was（230.00±65.4） mL in the LAVH group and（180.56±58.3） mL in the modified group.There were 4 patients with instraoperative complications in the LAVH group and only 1 patient in the modified group.There were 7 patients with vaginal stump bleeding in the LAVH group and only 2 in the modified group.The postoperative hospital stay was（6.5±2.5） d in the LAVH group,and（6.4±3.0） d in the modified group.Compared with the LAVH group,the surgery duration and intraoperative blood loss in the modified group were obviously less and the difference was statistically significant（P0.01）.The intraoperative complications were less in the modified LAVH group.The two groups showed no significant differences in terms of hospital stay（P0.01）.Conclusion The modified LAVH has advantages of shorter surgery duration,less bleeding and more minimal surgical invasion.