腹腔镜下全子宫切除与腹腔镜辅助阴式子宫切除的比较

Comparison between Total Laparoscopic Hysterectomy and Laparoscopic-assited Vaginal Hysterctomy

目的对比分析腹腔镜全子宫切除术(total laparoscopic hysterectomy,TLH)和腹腔镜辅助阴式子宫切除术(laparoscopic-assisted vaginal hysterectomy,LAVH)的临床价值。方法回顾性比较2007年1月～2012年1月1034例TLH和LAVH的手术时间、出血量、排气时间、住院时间、子宫重量及术后病率、泌尿系损伤、肠管损伤、血管损伤等并发症。结果 1034例手术均顺利完成,无中转开腹。TLH组手术时间(80.4±19.2)min与LAVH组(80.2±17.8)min无显著性差异(t=0.166,P=0.868);LAVH组出血量(53.4±14.3)ml显著多于TLH组(49.8±16.8)ml(t=-3.596,P=0.000);LAVH组排气时间(27.1±5.5)h显著长于TLH组(24.6±5.1)h(t=-7.059,P=0.000);LAVH组住院时间(5.4±1.2)d显著长于TLH组(5.1±1.4)d(t=-3.581,P=0.000)。LAVH组切除的子宫重量(286.1±28.2)g,与TLH组(279.6±27.4)g有显著性差异(t=-3.528,P=0.000)。术后病率TLH组1.4%和LAVH组1.7%无显著性差异(χ2=0.122,P=0.727)。术后泌尿系统损伤1例(LAVH组)、肠管损伤1例(TLH组)、血管损伤2例(2组各1例),2组并发症发生率无统计学差异[0.6%(2/345)vs.0.3%(2/689),χ2=0.031,P=0.861]。术后随访0.5～5年,平均3.9年,无切口感染、切口疝、出血等并发症发生。结论 TLH和LAVH均是安全可行的。

Objective To analyze the efficacy of total laparoscopic hysterectomy （TLH） and laparoscopic-assisted vaginal hysterectomy （LAVH）. Methods A retrospective analysis was carried out in 1034 cases of TLH or LAVH in Beijing Capital International Airport Hospital and Beijing Anzhen Hospital from January 2007 to January 2012, in respect of operation time, intraoperative blood loss, recovery time of gastrointestinal function, hospital stay, weight of removed uterus, and postoperative morbidity and complications. Results The laparoscopic procedures were completed in all the 1034 cases. No significant difference was observed in operation time [ （80.4 ± 19.2） min vs. （80.2 ± 17.8） min, t = O. 166, P = O. 868 ± and postoperative morbidity （1.4% vs. 1. 7%, X2 = 0. 122, P= 0. 727） between the two groups. The mean intraoperative blood loss, recovery time of gastrointestinal function, hospital day, and weight of removed uterus of the TLH group were all significantly less than those of LAVH group [（49.8 ±16.8） mlvs. （53.4±14.3） ml, t= -3.596, P=0.000; （24.6 ±5.1） hrs. （27.1 ±5.5）h, t= -7.059, P= 0.000; （5.1±1.4） dvs. （5.4±1.2） d, t= -3.581, P=0.000; （279.6＋27.4） gvs. （286.1 ＋28.2） g, t= -3.528, P= 0. 000 ]. There happened postoperative urinary system injury in 1 case （ 0. 1% ） , intestinal eanal damage in 1 ease （ 0.1% ） , and vascular injury in 2 cases. No significant difference was detected in the rate of complications between the two groups [ 0. 6% （2/345） vs. O. 3% （2/689） , X2 =0. 031, P =0. 861 ]. The 1034 patients were followed up for 6 months to 5 years with a mean of 3.9 years, no incisional infection, hernia or hemorrhage occurred. Conclusion TLH and LAVH are safe and reliable.