腹腔镜辅助下阴式大子宫切除术与开腹大子宫切除术的比较研究

Comparison between Laparoscopic-assisted Transvaginal Hysterectomy and Transabdominal Hysterectomy for Big Uterus

目的探讨腹腔镜辅助下阴式子宫切除术(laparoscopic assisted transvaginal hysterectomy,LAVH)在大子宫切除中的临床价值。方法 2009年1～12月62例LAVH,与同期35例开腹大子宫切除术(transabdominal hysterectomy,TAH)进行比较,比较2组手术时间、术中出血量、术后排气时间、术后住院时间及术后病率。结果 LAVH组术中出血量(114.3±53.5)ml明显少于TAH组(193.3±58.4)ml(t=-6.756,P=0.000),术后排气时间(32.6±13.7)h早于TAH组(43.7±13.9)h(t=-3.812,P=0.000),术后住院(5.6±1.8)d明显短于TAH组(7.2±1.8)d(t=-4.204,P=0.000),术后病率5例显著少于TAH组9例(χ2=5.643,P=0.018)。2组手术时间分别为(106.1±33.6)min和(104.3±23.8)min,无统计学差异(t=0.280,P=0.780)。2组患者术后第1、3、6、12个月随访,恢复良好,无术后严重并发症发生。结论与TAH相比,采用LAVH切除大子宫术中出血少,术后恢复快。

Objective To evaluate laparoscopic-assisted transvaginal hysterectomy （LAVH） for patients with big non- prolapsed uterus. Methods From January to December 2009, we performed LAVH on 62 patients, 35 patients who received transabdominal hysterectomy （TAH） during the same period were set as a control. The operation time, intraoperative blood loss, recovery time of gastrointestinal function, as well as postoperative hospital stay and morbidity of the two groups were compared. Results The LAVH group had significantly less intraoperative blood loss, shorter recovery time of gastrointestinal function, shorter postoperative hospital stay, and lower postoperative morbidity than the TAH group [ （114.3 ± 53.5） ml vs. （193.3 ± 58.4） ml （t = -6.756, P=0.000）; （32.6±13.7） hvs. （43.7±13.9） h （t= -3.812, P=0.000）; （5.6±1.8） dvs. （7.2±1.8） d （t= -4. 204, P = 0. 000）; and 5 eases vs. 9 cases （X2 = 5. 643, P = 0. 018 ）]. No significant difference was detected in the operation time between the two groups [ （ 106.1 ± 33.6） min vs. （ 104.3 ± 23.8） min （ t = 0. 280, P = 0. 780） ]. Both the groups were followed up at 1, 3, 6, and 12 months after the procedure, and none of the patients showed severe postoperative complications. Conclusion LAVH is superior to TAH in terms of intraoperative blood loss and postoperative recovery.