LAVH与TLH对子宫肌瘤患者术后恢复和安全性对比观察

Comparative study of the postoperative recovery and safety of laparoscopic assisted vaginal hysterectomy and laparoscopic total hysterectomy for treating women with hysteromyoma

目的:对比腹腔镜辅助下阴式子宫切除术(LAVH)与腹腔镜子宫全切术(TLH)对子宫肌瘤患者术后恢复和安全性。方法:回顾性收集2018年1月—2019年5月在本院接受治疗的子宫肌瘤患者60例临床资料,依据不同治疗方式分为LVAH组和TLH组各30例。对比两组手术情况,术后白细胞计数(WBC)、中性粒细胞百分比水平,盆底功能恢复情况及并发症,随访术后6个月。结果:LAVH组和TLH组下床活动时间及住院时间比较无差异(P>0.05);TLH组手术时间(81.0±10.1min)、术中出血量(104.1±12.5ml)少于LAVH组(95.2±13.3min、137.9±17.5ml),排气时间(22.2±3.6h)多于LAVH组(16.8±2.4h)(P<0.05)。两组WBC、中性粒细胞百分比水平及并发症总发生率(6.7%、6.7%)无差异(P>0.05)。术后6个月随访两组均无复发。结论:LAVH与TLH均是治疗子宫肌瘤的微创、有效术式,但THL较LAVH具有手术时间短、出血少优势,LAVH对胃肠功能影响较小,临床应综合多方面因素为患者提供最佳手术方案。

Objective:To compare the postoperative recovery and safety of laparoscopic assisted vaginal hysterectomy(LAVH)and laparoscopic total hysterectomy(TLH)for treating women with hysteromyoma.Methods:The clinical data of 60 women with hysteromyoma from January 2018 to May 2019 were collected retrospectively.The women were divided into group A(30 women accepted LVAH)and group B(30 women accepted TLH)according to different treatments.The operation conditions,the postoperative white blood cell(WBC)count,the neutrophil percentage value,the situation of pelvic floor function recovery,and the complications rate of the women were compared between the two groups.The women had been followed up for 6 months after operation.Results:There were no significant differences in the time of getting out of bed and hospitalization time of the women between the two groups(P>0.05).The operative time(81.0±10.1 min)and the intraoperative blood loss(104.1±12.5 ml)of the women in group B were significant lower than those(95.2±13.3min and 137.9±17.5ml)of the women in group A,but the exhaust time(22.2±3.6h)of the women in group B was significant higher than that(16.8±2.4h)of the women in group A(P<0.05).There were no significant differences in the WBC count and the neutrophil percentage of the women between the two groups,and the total incidence of complications(6.7%vs.6.7%)of the women had no significant different between the two groups(P>0.05).After 6 months followed up,there was no any woman with recurrence of hysteromyoma in both groups.Conclusion:LAVH and TLH are both minimally invasive and effective surgery for treating hysteromyoma,but THL has the advantages of shorter operation time and less bleeding compared with LAVH,and LAVH has less influence on gastrointestinal function.So,the clinical application of LAVH or TLH should integrate various factors to provide the best surgical scheme for the women with hysteromyoma.