大子宫全切除术的三种术式分析

Analysis of three kinds of surgery for large total hysterectomy

目的比较三种不同术式大子宫全切除术的适应证、疗效及手术并发症。方法选取在安康市中心医院妇产科行大子宫切除术的患者399例,根据手术治疗方式分为腹腔镜下切除术组（TLH组）、开腹切除术组（TAH组）和经阴道切除组（TVH组）。比较三组患者围手术期指标和手术并发症发生率的差异。结果 TLH组、TAH组和TLH组在手术时间、出血量、排气时间、术后HGB下降值、镇痛药物使用率和住院时间上相比差异性显著且具有统计学意义（F/χ^2值分别为66.318、51.380、19.726、74.094、49.914、83.652,均P〈0.001）;TLH组、TAH组和TLH组手术并发症发生率有显著性差异（χ^2=12.522,P〈0.001）,TLH组手术并发症的发生率为12.50%（10/83）,TVH组手术并发症发生率为8.44%（13/154）,均低于TAH组（22.22%,36/162）。结论腹腔镜下大子宫全切除术在手术疗效、安全性和可行性上优于开腹切除术和经阴道切除术,不会增加手术的危险性和手术并发症。

Objective To compare the indications,therapeutic effects and surgical complications among three different kinds of surgery for large total hysterectomy. Methods Totally 399 patients with hysterectomy in Ankang Central Hospital were divided into total laparoscopic hysterectomy（ TLH） group,transabdominal hysterectomy（ TAH） group and transvaginal hysterectomy（ TVH） group according to surgical methods. The differences in perioperative indicators and incidence of surgical complications were compared among three groups. Results The operative duration,amount of bleeding,evacuation time,HGB decreased value after operation,application of analgesic drug,and length of hospital stay were significantly and statistically different among three groups（ F / χ^2value was 66. 318,51. 380,19. 726,74. 094,49. 914 and 83. 652,respectively,all P〈0. 001）. The difference in incidence of operative complications among three groups was statistically significant（ χ^2= 12. 522,P〈0. 001）. The incidence of operative complications was 12. 50%（ 10 /83） and 12. 50%（ 10 /83）in TLH group and TVH group,respectively,which was higher than that（ 22. 22%,36 /162） in TAH group. Conclusion The therapeutic effect,safety and feasibility of TLH are better than those of TAH and TVH,and it will not increase risk and surgical complications.