3种全子宫切除术的临床应用分析与比较

Clinical application of analysis and comparison on three kinds of total hysterectomy

目的比较不同大小子宫的经腹全子宫切除术(TAH)、阴式全子宫切除术(TVH)及腹腔镜全子宫切除术(LTH)的临床效果。方法回顾性分析全子宫切除术118例患者的临床资料,根据子宫大小分为两组,子宫≥12孕周为A组,共59例,其中采用TAH 16例,采用LTH 19例,采用TVH 24例;子宫<12孕周为B组,共59例,其中采用TAH 8例,采用LTH 12例,采用TVH 39例。比较两组患者在不同手术方式下的手术时间、术中出血量、术后肛门排气时间。结果 A组中,TAH与LTH及TVH相比,手术时间短、术中出血量少(P<0.05)。B组中,TVH及LTH与TAH相比,手术时间、术中出血量、术后恢复时间差异无统计学意义(P>0.05)。结论 3种全子宫切除术均为有效的手术方式,各有利弊,子宫≥12孕周的患者,采用TAH更具优越性,子宫<12孕周的患者,应根据患者的具体情况、术者的技术水平,选择合适的术式。

Objective To compare the clinical effect of total abdominal hysterectomy （TAH） and vaginal hysterectomy （TVH） and laparoscopic total hysterectomy,（LTH） on different size of uterus. Methods A clincal date of 118 patients with hysterectomy were retrospectively analyzed.They were divided into two groups according to the size of Uterus.59 cases in group A,the uterus was equal to or greater than 12 gestational weeks pregnant size,16 patients were performed with TAH,19 patients were performed with LTH,24 patients were performed with TVH;59 cases in group B,the uterus was smaller than 12 gestational weeks pregnant size.8 patients were performed with TAH,12 patients were performed with LTH,39 patients were performed with TVH.Then analyzed the operation time,the amount of bleeding,the time of exsufflation through anus after operation. Results In group A,the operation time and the amount of bleeding of TAH were less than LTH and TVH （P〈0.05）;In group B,there were no difference for the operation time,the amount of bleed- ing,the time of exsufflation through anus after operation between TVH and LTH and TAH （P〉 0.05）. Conclusion TAH and LTH and TVH are all effective ways for panhysterectomy.Each metrectomy has respective advantages and disad- vantages. TAH is more advantages for patients who＇s uterus is equal to or greater than 12 gestational weeks pregnant size.For patients who＇s uterus is smaller than 12 gestational weeks pregnant size,we should make a choice according to the patients conditions and the technical level of the doctors.