腹腔镜辅助阴式子宫全切术与经腹子宫全切术的疗效比较

Comparison of Curative Effect of Laparoscopically Assisted Vaginal Hysterotomy and Abdominal Total Hysterectomy

目的比较腹腔镜辅助阴式子宫全切术(LAVH)与经腹子宫全切术(TAH)的临床效果。方法方便收集通州区人民医院妇科2010年7月—2016年12月行子宫切除的患者86例,其中开腹子宫全切术42例(TAH组),腹腔镜辅助阴式子宫全切术44例(LAVH组)。比较两组患者手术情况和并发症等情况。结果 LAVH组手术时间(116.7±26.4)min虽然较TAH术(87.3±23.6)min长,但是在出血量(37.5±17.3)m L和肛门排气时间(16.8±7.1)h等指标要显著优于TAH组(95.8±9.4)m L和(45.9±12.2)h(P<0.05)。LAVH组患者术后并发症只有阴道残端感染1例、胃肠功能紊乱2例、阴道残端感染、切口延期愈合、胃肠功能紊乱、血栓性静脉炎各项并发症例数上都少于TAH组(P<0.05)。术后3个月复查,LAVH组阴道残端息肉1例,TAH组阴道残端息肉3例。两组患者术后性生活质量无明显差异(P<0.05)。结论LAVH较TAH能够明显缩短排气时间及住院时间,减少术中出血量,降低术后并发症的发生率,值得临床进一步推广应用。

Objective To compare the clinical effect of laparoscopically assisted vaginal hysterotomy and abdominal total hysterectomy. Methods Convenient selection 86 cases of patients with hysterectomy in our hospital from July 2010 to December 2016 were selected and divided into the TAH group with 42 cases and LAVH group with 44 cases, and the operation situation and complications situation were compared between the two groups. Results The operation time in the LAVH group was longer than that in the TAH group[(116.7±26.4)min vs(87.3±23.6)min], but the bleeding amount, anus exhaust time were obviously better than those in the TAH group[(37.5±17.3)m L,(16.8±7.1)h vs(95.8±9.4)m L,(45.9±12.2)h(P<0.05), and in the LAVH group, there was 1 case with vaginal stump infection and 2 cases with gastrointestinal dysfunction,and the occurrence causes of various complications of vaginal stump infection, incision extended healing, gastrointestinal dysfunction and thrombophlebitis were lower than those in the TAH group(P <0.05), and there was 1 case with vaginal stump infection and 3 cases in the vaginal stump infection in the LAVH group and in the TAH group by the reexamination after surgery, and there was no obvious difference in the postoperative sex quality of life between the two groups(P>0.05).Conclusion The LAVH can obviously shorten the exhaust time and length of stay compared with those of TAH, and reduce the intraoperative bleeding amount and incidence rate of postoperative complications, and it is worth further promotion and application in clinic.