四种腹腔镜子宫切除术的临床对比分析

Clinically comparative analysis of four kinds of laparoscopic hysterectomy

目的:探讨腹腔镜子宫次全切除术(laparoscopically subtotal hysterectomy,LSH)、腹腔镜筋膜内子宫切除术(laparoscopically intrafascial supercervical hysterectomy,LISH)、腹腔镜辅助阴式子宫切除术(laparoscopic assisted vaginal hysterectomy,LAVH)、腹腔镜全子宫切除术(laparoscopically total hysterectomy,LTH)的临床应用价值。方法:回顾分析2006年1月至2011年12月为640例患者行腹腔镜子宫切除术的临床资料,并对比分析4种术式的手术时间、术中出血量、手术并发症。结果:LISH组手术时间、术中出血量、并发症发生率明显高于其他3组(P<0.05),LTH组手术时间明显优于其他3组(P<0.05)。结论:4种术式各有优势,其中LISH存在较大弊端,可采用改良术式或LSH,LAVH可作为LTH的过渡术式进行训练。术者应根据患者病情、宫颈病变情况及术者自身技术水平等综合分析,合理选择适宜术式。

Objective：To evaluate the clinical application value of four kinds of hysterectomy-laparoscopieally subtotal hyster- ectomy （ LSH）, laparoscopieally intrafascial supereervieal hysterectomy （ LISH）, laparoscopic assisted vaginal hysterectomy （ LAVH ） and laparoscopieally total hysterectomy （LTH）. Methods： The clinical data of 640 patients who underwent laparoscopic hysterectomy from Jan. 2006 to Dec. 2011 were retrospectively analyzed. The operation time, the blood loss and the operative complications of four kinds of hysterectomy were comparatively analyzed. Results： The operation time, the blood loss and the operative complications of LISH was （ 110.5 ± 32.1 ） rain, （ 256.5 ± 54.3 ） ml and 7.45 %, respectively, which were higher than the others （ P 〈 0.05 ）. The operative time of LTH was （65.1 ±25.4 ） rain, which was less than the others （ P 〈 0. 05 ）. Conclusions ： Different procedures have their own ad- vantages and disadvantages. LISH has more disadvantages, surgeons can choose improved style or LSH. LAVH can be a training for tran- sition to LTH. Rational selection of appropriate laparoseopic hysterectomy depends on the diagnosis, the cervical lesions and the ability of the doctor.