摘要
目的比较及评价用不同微创术式行全子宫切除以治疗良性子宫病变及癌前病变的临床效果。方法回顾性分析自1996年10月～2005年2月的8年期间,由同一组医生所处理的523例良性或癌前病变患者的资料。其中阴式全子宫切除术(TVH)318例,腹腔镜辅助下阴式全子宫切除术(LAVH)177例,完全性腹腔镜全子宫切除术及腹腔镜下全子宫切除术(TLH/LH)28例。进一步将该时期分为前4年(自1996年10～2000年12月)及后4年(自2001年1月～2005年2月)。在前4年,TVH占81%,LAVH占19%,后4年TVH占35%,LAVH及TLH/LH占65%。对比分析了不同微创术式手术适应证、手术时间、出血量、并发症及优缺点。结果3组患者主要手术适应证均为子宫肌瘤、子宫肌腺病及CINIII。TVH组平均手术时间及平均出血量均明显低于LAVH和TLH组(P<0.001)。3种术式各有其主要优点和适应证。MIS最突出的优点是疼痛轻、出血少及恢复快,尤其腹腔镜下操作,视野清楚,对合并有盆腔粘连和附件包块者尤为适合。3组术式术中和术后并发症无明显差异。后4年手术时间明显短于前4年。结论各种术式的微创手术行子宫切除,各具有其利弊和相应的适应证。术中出血量多少、手术时间长短及是否有并发症与手术者的技术、仪器设备及患者条件,如子宫大小及是否有盆腔粘连等因素有密切关系。在决定手术方式时,慎重考虑各种术式利弊及上述相关因素,避免并发症的发生,是手术成功的关键。
[Objective] To compare and assess the clinical outcomes of different types of minimal invasive surgery （MIS） in treatment of gynecologic benign disease or pre-malignant disease. [Methods] A Retrospective study. 523 patients diagnosed as gynecologic benign and pre-malignant diseases were undergone total hysterectomy with MIS by the same surgical team from 1996 to 2005. Of these patients, 318（61%） were performed by total vaginal hysterectomy （TVH）; 177（34%） by Laparoseopic-assisted vaginal hysterectomy （LAVH） and 28 （5%） by total laparoseopic hysterectomy / laparoseopic hysterectomy （TLH/LH）. For further analysis, the study was divided into two periods. In first period （from Oct.1996 to Dec. 200（0, the percentages for patients who underwent TVH and LAVH were 81% and 19% respectively. In second period （from 1/2001 to 4/2005）, the percentages for that were 35% and 65%, respectively. The outcomes for three types MIS were analyzed. [Results] The most common indications for three groups were Fibroid, adenomyosis and CINⅢ. The shorter operation time and less average amount of blood loss were observed in TVH group than that in the LAVH and TLH/LH groups. The advantages of MIS of hysterectomy are less pain, quick recovery and shorter hospital stay. In addition, the marked advantages for lapamseopic group are more clear view for pelvic anatomy, safer for patients with pelvic adhesion and much easier for adnexectomy. Operation time in the fLrSt period was longer than second period （93.69min vs. 67.69 rain for TVH; 131.5min vs. 109minfor LAVH）. There was no significant difference of complications for these three groups. [Conclusion] Three types of MIS procedure have their distinctive advantages. For all MIS of total hysterectomy, the operative duration, the amount of blood lost and the complications were tied up with the skills of surgeon, instrumentations, size of uterus and presence of pelvic adhesion. To make a right decision for the patient who has the indication for hysterectomy,
出处
《中国内镜杂志》
CSCD
北大核心
2007年第2期113-116,共4页
China Journal of Endoscopy
