全子宫切除3种术式的比较

Comparison of three methods for hysterectomy

目的：比较开腹全子宫切除术（TAH）、经阴道全子宫切除术（TVH）和腹腔镜辅助阴式全子宫切除术（LAVH）3种手术方式的临床疗效。方法分析2010年4月至2013年4月收治的行子宫切除术患者300例，其中TAH 154例，TVH 48例， LAVH 98例。对3组患者的手术时间、出血量、术后下床活动时间、肛门排气时间、镇痛泵使用率、切口愈合情况、住院时间和住院费用等进行比较分析。结果154例TAH中有8例切口脂肪液化，发生率为5．19％。98例LAVH中有3例中转开腹，发生率为3．06％。3组患者手术时间和术中出血量无显著性差异（F值分别为0．43、0．39，均P＞0．05），而术后排气时间、术后下床活动时间、住院时间和住院费用均有显著性差异（F值分别为616．95、430．85、213．38、7970．40，均P＜0．05），镇痛泵使用有显著性差异（χ2＝126．61，P＜0．05）。结论腹腔镜辅助阴式全子宫切除术损伤小，并发症低，术后疼痛轻，恢复快，住院时间短，是一种安全有效的子宫切除手术。

Objective To compare the clinical effect of total abdominal hysterectomy （TAH）, total vaginal hysterectomy （TVH） and laparoscopically assisted vaginal hysterectomy （LAVH）.Methods Totally 300 cases undergoing hysterectomy during the period of April 2010 to April 2013 were selected, including 154 cases of TAH, 48 cases of TVH and 98 cases of LAVH.The operation time, intra-operative bleeding, activity time after leaving bed, anus exhaust time, analgesia pump utilization, wound healing, hospital stay time and fee were compared among three groups.Results There were 8 cases （ 5.19%） with poor wound healing in TAH group, and 3 cases （3.06%） were converted to TAH in LAVH group.There was no significant difference among three groups in the operation time and intra-operative bleeding （F value was 0.43 and 0.39, respectively, both P〉0.05）, but the differences in anus exhaust time, activity time after leaving bed, hospital stay time and fee were significant （ F value was 616.95, 430.85, 213.38 and 7970.40, respectively, all P〈0.05）.There was significant difference among three groups in analgesia pump utilization （χ2 =126.61,P〈0.05）.Conclusion LAVH has the advantages of mild damage, good effect, few complications, less pain, fast recovery and short hospital stay.It is an effective and safe surgery method.