腹腔镜与阴式全子宫切除术治疗子宫良性疾病的疗效观察

A comparative study of the efficiency of laparoscopic and vaginal total hysterectomy for benign uterine diseases

目的:比较腹腔镜与阴式全子宫切除术治疗子宫良性病变的临床效果。方法:回顾分析2012年1月至2013年1月为105例子宫良性疾病患者行全子宫切除术的临床资料,其中55例行腹腔镜子宫切除术(腹腔镜组),50例行阴式子宫切除术(阴式组)。对比分析两组患者疾病种类、年龄、手术时间、术中出血、术后康复、并发症等情况。结果:两组患者在疾病种类、年龄、术前血红蛋白、合并内科疾病、子宫重量及术后并发症、术后住院时间等方面差异均无统计学意义(P>0.05),盆腔粘连例数及术中失血量腹腔镜组优于阴式组,差异均有统计学意义(P<0.05),但手术时间、术后排气时间长于阴式组(P<0.05)。结论:腹腔镜及阴式子宫切除术各有优缺点,相较阴式手术,腹腔镜全子宫切除术手术视野更清晰,尤其合并子宫内膜异位症、盆腔粘连等疾病的患者。术者应根据手术指征、自身手术经验及盆腔解剖关系选择合适的手术方式。

Objective： To compare the clinical efficiency of laparoscopic total hysterectomy （LTH） and vaginal total hysterecto- my （VTH） on benign uterine diseases. Methods：The clinical data of 105 patients who suffered from benign uterine diseases and under- went total hysterectomy from Jan. 2012 to Jan. 2013 were retrospectively analyzed. The patients were assigned into 2 groups：the laparo- seopic group （ underwent LTH,55 cases） and vaginal group （ underwent VTH,50 cases）. The type of disease, age, operative time, blond loss, recovePy time and complications were comparatively studied between the 2 groups. Results：There was no significant difference be- tween the 2 groups in terms of the type of disease, age, preoperative hemoglobin, combined diseases, uterus weight, complications or post- operative hospital stay （ P 〉 0.05 ）. There were more pelvic adhesion and less blood loss in the laparoscopic group （P 〈 0.05 ）. Howev- er,the operative time and anal aerofluxus time were significantly longer in the laparoscopic group than those in the vaginal group （P 〈 O. 05 ）. Conclusions ： Both LTH and VTH have advantages and disadvantages. LTH has clearer operative field, especially in patients with endometriosis or pelvic adhesion. The surgical method should be determined on the basis of surgical indications,operative skills and pelvic anatomy.