三种不同子宫切除术式的临床特征比较

Comparative Study on the Clinical Features of Three Different Approach Routes in Hysterectomy

目的探讨腹式子宫切除术、阴式子宫切除术及腹腔镜筋膜内子宫切除术的各自临床价值。方法1 90例子宫良性疾病中 ,71例行腹式子宫切除术 (A组 )、6 5例行阴式子宫切除术 (B组 )及 5 4例行腹腔镜筋膜内子宫切除术 (C组 )。对三组患者的手术时间、出血量、术后疼痛程度、肠蠕动恢复时间、保留尿管时间、住院天数、住院费用及随访一年的情况进行比较。结果C组较A组、B组术后疼痛轻 ,肠蠕动恢复快 ,保留尿管时间短 ,离床活动时间早 ,且差异有显著性 (P <0 .0 1或 0 .0 5 ) ;A、B组之间相比较差异无显著性。术后一年随访中C组膀胱功能及性功能术前、术后无明显改变 ,较A、B组差异有显著性 (P <0 .0 1或 0 .0 5 )。A组较B、C组手术时间均短且差异有显著性 (P <0 .0 1 )。C组较A、B组医疗费用高、手术时间长且差异有显著性 (P <0 .0 1 )。结论三种子宫切除术式各有其利弊 ,随着腔镜技术的发展 ,腹腔镜筋膜内子宫切除术的优势更趋明显 。

ObjectivesTo evaluate the clinical application of transabdominal total hysterectomy, transvaginal total hysterectomy and pelviscopic intrafascial SEMM hysterectomy.MethodsOne hundred and ninety cases with benign diseases of uterus were divided into 3 groups : Group A, transabdominal total hysterectomy was performed in 71 cases; Group B, transvaginal total hysterectomy was performed in 65 cases ; and Group C, pelviscopic intrafascial SEMM hysterectomy in 54 cases. The time of operation, volume of bleeding, intensity of postoperative pain, recovery time of intestinal peristalsis, time of urinary catheter reservation, duration and cost of hospitalization as well as the patient conditions during one year follow up were compared among these three groups.ResultsPatients in Group C displayed mild postoperative pain , earlier recovery of intestinal peristalsis and earlier rehabilitation, with shorter time of urinary catheterization as compared with Groups A and B (P<0.01 or 0.05). No significant difference was found in those criteria between Group A and B. The function of urinary bladder and sexual function in patients of Group C showed no distinct discrepancy before and after operations, but showed more prominent than those of Groups A and B (P<0.01 or 0.05). The time of operation in Group A was shorter than that of Groups B and C (P<0.01), expensive cost of hospitalization and longer time of operation were recorded in Group C when it was compared with other two groups (P<0.01).Conclusion Three types of hysterectomy have. their advantages and disadvantages separately, With the development of laparoscopic technology, superiority of pelviscopic intrafascial SEMM hysterectomy becomes obvious and it is an ideal route of approach.