阴式子宫切除术与腹腔镜辅助阴式子宫切除术的临床对比

Clinical comparative study on vaginal hysterectomy with laparoscopically assisted vaginal hysterectomy

目的分析阴式子宫切除术(TVH)和腹腔镜辅助阴式子宫切除术(LAVH)的临床效果并探讨术式的合理选择方案。方法采集笔者所在医院2009-10～2012-05行TVH的53例患者(TVH组)及行LAVH的61例患者(LAVH组)的临床资料,对其手术时间、术中出血量、术后住院时间、排气时间、是否需要镇痛、住院费用进行对比分析。结果 TVH组与LAVH组,术后排气时间、住院时间、术后镇痛率相比无统计学差异(P>0.05)。TVH组较LAVH手术时间偏长、出血量偏多(P<0.05),但住院费用低于LAVH组(P<0.05)。结论 LAVH与TVH均属于妇科微创手术,两种术式在患者术后恢复方面无显著性差别。但LAVH组手术时间短、出血量少,相对减轻了患者术中的创伤,并且对于子宫较大、附件存在病变的患者,LAVH弥补了TVH的不足。对于两种术式的选择,应根据临床患者特点及临床医师的手术技巧进行个性化选择,以达到最好的治疗效果。

Objective To evaluate and compare clinical effects of vaginal hysterectomy （TVH） with laparoscopically assisted vaginal hysterectomy（LAVH） and discuss the right choice of surgery methods. Methods The clinical data of 53 patients who had received TVH and 61patients who had received LAVH in anthor＇s hospital from October 2009 to May 2012 were collected; their operation time, blood loss volume, hospitalization time, farting time, the rate of postoperative analgesia and hospitalization cost were compared each other. Results There was no significant difference of farting time, hospitalization time, the rate of postoperative analgesia between TVH and LAVH（P〉0.05）; TVH showed longer operation time and more blood loss than LAVH（P〈0.05）. But the hospitalization cost of TVH was lower than that of LAVH （P〈0.05）. Conclusion TVH and LAVH both belong to minimally invasive operation. They showed no significant difference on postoperative recovery of the patients. But LAVH showed shorter operation time and less blood loss than that of TVH. Generally speaking, LAVH reduced the trauma of patients in the operation. To the patient who has bigger uterus or has adnexa disease, LAVH is a better choice than TVH. The choice of TVH and LAVH should be according to the characteristics of disease and the operation skills of the doctor.