腹式与困难阴式全子宫切除术对子宫良性病变患者的影响对比

Effect of TAH and TVH on patients with benign uterine lesions

目的探究腹式全子宫切除术(TAH)与困难阴式全子宫切除术(TVH)对子宫良性病变患者术中术后指标及随访情况的影响。方法选取淮安市妇幼保健院在2015年1至12月期间收治的、符合纳入标准的子宫良性病变患者50例。根据手术方法的不同,分为腹式组(n=12)和阴式组(n=38)。阴式组分为3个亚组,即大子宫组(n=20)、多种困难因素并存组(n=13)以及既往盆腔手术史或内膜异位症组(n=5)。对比两组术中出血量、手术时间、术后发热、住院时间等术中术后情况;术后随访6个月,记录患者并发症及性生活满意度情况。结果与腹式组相比,阴式组的术中出血量、手术时间、术中输血例数、术后发热、术后排气时间及住院时间均较低,差异具有统计学意义(t/χ~2值分别为11.56、9.13、4.41、8.65、13.40、9.91,均P<0.05)。术后随访6个月,两组并发症及性生活满意度比较无明显差异(χ~2=0.07,P>0.05)。阴式组组间比较发现,大子宫组的子宫重量高于其他两组(F=56.09,P<0.01);多种困难因素并存组的手术时间长于其他两组(F=49.02,P<0.01);3个亚组术中出血量比较无明显差异(F=0.17,P>0.05)。结论改良困难阴式全子宫切除术具有微创、安全、有效等特点,值得临床推广。

Objective To analyze the effect of total abdominal hysterectomy（TAH）and transvaginal hysterectomy（TVH）on intraoperative and postoperative indexes and follow-up of patients with benign uterine lesions.Methods Fifty patients with benign uterine lesions in Huai＇an Maternal and Child Health-Care Center were collected from January to December in 2015.According to different surgical methods,the patients were divided into TAH group（n=12）and TVH group（n=38）.The TVH group was divided into 3 subgroups：large uterus group（n=20）,multiple difficulties group（n=13）and history of pelvic surgery or endometriosis group（n=5）.The intraoperative blood loss,operative time,postoperative fever and hospital stay were compared between two groups.The complications and sexual life satisfaction were recorded in 6-month follow-up.Results Compared with patients in TAH group,those in TVH group had less intraoperative bleeding volume,shorter operation time,fewer cases with intraoperative blood transfusion,lower incidence of postoperative fever,earlier postoperative exhaust time and shorter hospital stay,and the differences were statistically significant（t/χ~2 value was 11.56,9.13,4.41,8.65,13.40 and 9.91,respectively,all P〈0.05）.Postoperative follow-up for 6 months revealed no significant difference in complications and sexual life satisfaction between two groups（χ~2=0.07,P〈0.05）.Group comparison of TVH group showed that uterus weight of large uterus group was higher than that in multiple difficulties group and history of pelvic surgery or endometriosis group（F=56.09,P〈0.01）,and that the operation time in multiple difficulties group was longer than that in other two groups（F=49.02,P〈0.01）.There was no significant difference in intraoperative blood loss among three groups（F =0.17,P〈0.05）.Conclusion Modified transvaginal hysterectomy is a minimally invasive,safe and effective method.It is worthy of clinical promotion.