中等大良性病变子宫经阴全子宫切除术的探讨

Discussion on vaginal hysterectomy for patients with moderately enlarged uterus of benign lesions

目的：探讨中等大、良性病变的非脱垂子宫经阴道行全子宫切除术的可行性。方法：87例施行此术式，其中子宫中等大（重200～750g）60例作为研究组，小子宫（＜200g）27例作为对照组，部分病例采用子宫分碎术。对两组因手术期情况进行分析。结果：研究组59倒成功地经阴道切除子宫，其中21例（35％）采用子宫分碎术，1例转经腹手术，转经腹手术率为1．7％，对照组则全部经阴道完整切除。研究组和对照组的子宫重量分别为280．18±100．40g、146．48±35．19g，差异有高度显著性（P＜0．001）；研究组的平均手术时间为83．93±26．26min,长于对照组的55．22±20．55min，差异有高度显著性（P＜0．001）；术中平均出血量为164．92±89．83ml，多于对照组的135．56±111．57ml，但差异无显著性（P＞0．05）；术后病率分别为3．33％与3．70％，差异无显著性（P＞0．05）；两组患者均无膀胱、直肠损伤，无阴道残端炎症。结论：对具备经阴道手术经验的术者，中等大、良性病变的子宫经阴道切除是安全可行的。部分病例需施行子宫分碎术，减小子宫体积，缩短手术时间，减少术中出血量和降低术后并发症。

objective: To evaluate the possibility of vaginal hysterectomy for patients with non - prolapse and moderately enlarged uterus of benign lesions. Methods: Eighty - seven women with uterine diseases underwent vaginal hysterectomy. These patients were divided into two groups. Group Ⅰ contained 60 patients with uterine enlargement to a weight of 200g to 750g and group Ⅱ contained 27 patients with uterine weighing less than 200g. Uterine morcel-lation was performed in some cases. The perioperative periods in two groups were analyzed. R esults:In group Ⅰ,59 cases successfully underwent transvaginal hysterectomy, except l case transferred to abdominal operation. The uterine morcellation was performed in 21 cases. In group Ⅱ,all successfully underwent transvaginal hysterectomy.The uterine weight of group Ⅰ was significantly heavier than that in group Ⅱ (280. 18 ±100.40g vs 146.48 ±35. 19g). The oper-ating time was significantly longer for group Ⅰ than for group Ⅱ (83 .93 1±26 .26min vs 35 .22 ±20. 55min). There were no significant differences in blood loss and complications between group Ⅰ and group Ⅱ. There were no injures of urinary bladder and rectum, and no residual vagina inflammatory diseases. Conclusions: Vaginal hysterectomy of moderately enlarged uterus can be safely and effectively performed by experienced operator. In some cases,uterine morcel-lations were used to reduce the volume for shortening operative time, reducing the bleeding and lowering the postoperative complications.