宫腔内良性病变宫腔镜手术与腹式子宫切除术的比较

THE COMPARATIVE OF TRANSCERVICAL RESECTION AND TRANSABDOMINAL HYSTERECTOMY TREAT FOR BENING PATHOLOGICAL CHANGES OF UTERINE CAVITY

目的 :比较宫腔镜手术 (TCR)和腹式全子宫切除术 (TAH)治疗功能失调性子宫出血 (DUB)、子宫内膜息肉、子宫肌瘤的临床经过、资源消耗情况、优点与不足。方法 :回顾性分析 1998年 1月 1日～ 1999年 12月 31日在我院行手术治疗的上述患者 4 19例。其中DUB 89例 ,子宫内膜息肉 98例 ,子宫肌瘤 2 32例。 2 6 7例行宫腔镜电切术 ,计宫腔镜子宫内膜切除术 139例 ,宫腔镜子宫内膜息肉切除术 5 2例 ,宫腔镜子宫粘膜下及壁间内突肌瘤切除术 76例 ;行腹式全子宫切除术 (TAH组 ) 15 2例。结果 :TCR组的平均手术时间、出血量、术后尿道刺激症状 ,术后病率均较TAH组少 ,术后排气时间早 ,统计学处理均有显著性差异。宫腔镜手术的手术费高于TAH术 ,但抗生素、治疗费和其它费用低 ,每例的总医疗费也低。TCR组药费占医疗费的比例明显低于TAH组 (16 .6 3%∶31.2 9% ) ,手术费占医疗费的比例明显高于TAH组 (44 .6 7%∶17.6 8% )。结论 :与TAH组相比 ,宫腔镜手术无切口 ,手术时间短 ,创伤小 ,出血量少 ,术后 10 0 %在 1d内排气 ,尿道刺激症状也少 ,术后病率低 ,使用抗生素少 ,药费低 ,占总医疗费的比例明显低于TAH术 ,总的医疗费也明显低于TAH术 ,因此宫腔镜手术还有价格上的优势 ,宫腔镜手术的效价比明显优于TAH术 ,故在有?

Objective: To compare the clinical course,resource consuming, advantages and disadvanges of transcervical resection (TCR) and transabdominal hysterectomy (TAH) to treat dysfunctional uterine bleeding (DUB), uterine polyp and submuous myoma. Methods: Four hundred and ninteen cases of above patients who were treated in our hospital from January 1998 to December 1999 were analyzed retrospectively. Among them 89 cases were DUB, 98 cases were uterine polyp, and 232 cases were myoma uteri. Two hundred and sixty seven cases were performed transcervical resection surgeries. One hundred and thirty nine cases were transcervical resection of endometrium, fifty-two cases were transcervical resection of polyp, and seventy-six cases were transcervicai resection of submucous myoma and intramural myoma protruded into uterine cavity. One hundred and fifty four case were performed TAH. Results: The mean operation time, bleeding amount, stimulative symptom of urethra and postoperative morbidity of TCR were lower than TAH. Postoperative bowel function recovery of TCR was earlier than TAH. There were obvious different statistically. The operating fees of TCR were higher then TAH. The fees of antibiotic,remedy, other expenses and the total expenses of medical fees of TCR were lower than TAH. The percentage of pharmacy fees in total medical fees of TCR was lower obviously then TAH (16.63%:31.29%) and the percentage of operating fees in total medical fees were higher than TAH obviously (44.67%: 17.68%). Conclusions: Compared with TAH TCR surgery was no incision,shorter of operating time, mini-invasive, less bleeding, 100% bowel function recovery within day, less stimulative symptom of urethra, lower postoperative morbidity, less antibiotics and fees of pharmacy percentage of pharmacy within total medical expenses and the total medical expenses of TCR is lower than TAH too. It is shown that TCR has the advantage of medical expenses. The ratio of effect over cost is better than TAH. Therefore TCR surgeries have to be the first choice treatment of benign intrauterine lesions, which is, indicated in the hospital where has the ability to perform.