腹腔镜辅助阴式子宫切除术与阴式子宫切除术258例临床分析

A comparison study on laparoscopic assisted vaginal hysterectomy and total vaginal hysterectomy——clinical analysis of 258 cases

目的探讨非脱垂子宫腹腔镜辅助阴式子宫切除术(LAVH)与阴式子宫切除术(TVH)的临床效果。方法回顾性分析2007年10月—2010年8月行LAVH 156例、TVH 102例患者的临床资料。比较两组手术适应证、手术时间、出血量、术后住院时间。结果 LAVH组手术时间略长于TVH组[(90.2±15.6)vs(77.5±17.3)]min,P<0.05)、并发症发生率显著低于TVH组(0.007%vs 0.089%,P<0.05);LAVH组与TVH组术中出血量[(88.4±11.2)vs(93.1±13.7)]ml、术后肛门排气时间(12.8±1.9)vs(13.7±1.2)h、住院时间(5.7±0.4)vs(5.6±0.6)d比较,差异无显著意义(P>0.05)。结论 LAVH较TVH术式具有更高的安全性,切除子宫大于孕12周或子宫肌瘤合并附件良性肿瘤、盆腔重度粘连的患者处理上明显优于TVH,具有广阔的应用及发展情景。

Objectlve To investigate the clinical effects of laparoscopic assisted vaginal hysterectomy（LAVH） and total vaginal hysterec- tomy（TVH） on patients with non-prolapsed uterus. Methods The clinical data of 258 patients undergoing total hysterectomy（ 156 cases in LAVH group, 102 cases in TVH group）from October 2007 to August 2010 were analyzed retrospectively. Analysis was made of surgical indications, operational time, postoperative anal exhaust time, incidence of complication, the bleeding and postoperative hospital stays. Re- sults The operations in both groups were all successful. Operation time of LAVH group was slightly longer than that of TVH group（90.2±15.6）vs （77.5 ±17.3 ）min, P 〈 0.05 ）and incidence of complication was significantly lower than that of TVH group（0. 007% vs 0. 089%, P 〈 0.05 ）. There were no significant difference between LAVH group and TVH group in perioperative bleeding（ 88.4± 11.2 ） vs （93.1 ± 13.7 ） ml, postoperative anal exhaust time （ 12.8±1.9） vs （ 13.7±1.2） h, and hospital stays （5.7±0.4） vs （5.6 ±0. 6） d （ P 〉 0.05）. Conclusion Both TVH and LAVH are safe and minimally invasive surgery. Compared with TVH, LAVH has obvious advanta- ges for the patients with the uterus with more than 12 weeks or uterine fibroids merger accessories benign tumor,pelvic adhesion,which has prospects of wide application and development.