阴式与腹腔镜子宫全切除术的临床效果比较

Comparison of clinical effect of vaginal and laparoscopic hysterectomy

目的:探讨阴式与腹腔镜子宫全切除术的疗效差异。方法:2013年2月-2014年3月收治行子宫全切除术患者368例,根据患者自愿分为阴式子宫切除术(TVH)组158例和腹腔镜辅助经阴道全子宫切除术(LAVH)组210例,TVH组采用阴式子宫切除术进行治疗,LAVH组采用腹腔镜辅助经阴道全子宫切除术。结果:LAVH组术后应用镇痛药物11例(5.2%),术后肛门排气时间(11.2±3.6)h,住院时间(4.9±1.3)d,发生并发症22例,并发症发生率10.5%。TVH组术后应用镇痛药物18例(11.4%),术后肛门排气时间(16.3±3.1)h,住院时间(7.3±1.1)d,发生并发症15例,并发症发生率9.5%。两组术后镇痛药物应用、术后肛门排气时间、住院时间比较差异有统计学意义(P<0.05),并发症发生率比较差异无统计学意义(P>0.05)。TVH组中转开腹1例,LAVH组中转开腹1例,对出现的并发症患者进行对症处理,所有患者均治愈出院。结论:LAVH组术后镇痛药物应用、术后肛门排气时间、住院时间明显优于TVH组,两组患者均各出现1例中转开腹,因此,要结合患者的具体实际,选择手术方式,减轻患者痛苦,提高临床疗效。

Objective:To explore the curative effect difference of vaginal and laparoscopic hysterectomy.Methods:368 patients with total hysterectomy patients were selected from February 2013 to March 2014.According to the voluntary of patients,they were divided into the vaginal hysterectomy(TVH) group of 158 cases and laparoscopic assisted vaginal hysterectomy(LAVH) group of210 cases.TVH group was treated with vaginal hysterectomy,and LAVH group was treated with laparoscopic assisted vaginal hysterectomy.Results:In LAVH group,11 cases(5.2%) used analgesics after operation;postoperative anal exhaust time was(11.2±3.6) hours;the time of hospitalization was(4.9±1.3) days;22 cases had complications;the complication rate was 10.5%.In TVH group,18 cases(11.4%) used analgesics after operation;postoperative anal exhaust time was(16.3 ± 3.1) hours;the time of hospitalization was(7.3±1.1) days;15 cases had complications;the complication rate was 10.5%.We compared the postoperative analgesic drug application,anal exhaust time,postoperative hospitalization time of the two gourps,and the difference was statistically significant(P<0.05).We compared the incidence of complications of the two gourps,and there was no significant difference(P>0.05).In TVH group,1 case was converted to open operation.In LAVH group,1 case was converted to open operation;patients with complications were given symptomatic treatment;all the patients were cured and discharged.Conclusion:In the LAVH group,the analgesic drug application after operation,postoperative anal exhaust time,hospitalization time were obviously better than those of TVH group.In each group,1 case was converted to laparotomy.Therefore,we should combine the concrete reality of patients to select the surgical approach,in order to alleviate the suffering of patients,and improve clinical curative effect.