摘要
目的探讨改良困难阴式全子宫切除术优越性、安全性及可行性。为拓展阴式全子宫切除术适应证提供科学依据。方法回顾分析2009年1月至2012年7月卫生部北京医院妇科因良性病变（非脱垂子宫）行全子宫切除术患者共237例，其中腹式全子宫切除术70例（TAH组），困难阴式全子宫切除术167例（TVH组）。TVH组分为3个亚组：大子宫组（宫体〉孕12周）100例、既往盆腔手术史和（或）子宫内膜异位症史组25例、多种困难因素并存组42例。比较两组术中术后及随访情况。结果手术时间、术中出血量及术中输血TVH组分别为（71±5）min、（228±25）ml及7例；TAH组分别为（104±10）min、（363±66）ml及11例，两组比较均P〈0．05。手术并发症两组差异无统计学意义。TVH组无中转开腹。TVH组术后发热时间、排气时间、住院时间短于TAH组（均P〈0．05），两组住院费用、术后1及6个月并发症、性生活满意率差异无统计学意义。TVH3亚组手术时间由长至短依次为多种困难因素并存组、大子宫组及既往盆腔手术史和（或）子宫内膜异位症史（P〈0．05），与手术时间相符，多种困难因素并存组术中出血大于其余两组（P〈0．05）。结论改良困难阴式全子宫切除术体现出微创、安全、将操作化繁为简的手术特点，是值得临床推广的实用术式。
Objective To explore the advantage, feasibility and safety of modified approach to difficult vaginal hysterectomy and provide scientific rationales for expanding its indications. Methods A retrospective study was conducted for 237 patients undergoing hysterectomy for benign disease of uterus （without prolapse） from January 2009 to July 2012. Both modified approach to difficult vaginal hysterectomy （TVH, n = 167） and abdominal hysterectomy （TAH, n =70） were performed. Two groups were compared for epidemiological, clinical characteristics, operative duration, intraoperative blood loss volume, perioperative and postoperative complications, hospitalization duration, inflammatory response and follow-up outcomes. TVH was divided into 3 subgroups of enlarged uterus （n = 100 ）, prior pelvic surgeries/ endometriosis history （n = 25 ） and complicated cases with multiple factors （n = 42）. Then the surgical outcome parameters were compared for each group. Results The operative duration, intraoperative blood Joss volume and blood transfusion amount were significantly less in the TVH group than those in the TAH group （ P 〈 0. 05 ）. No major perioperative complications occurred in either group. There was no conversion from TVH into TAH. Inflammatory response, gastrointestinal recovery and hospitalization duration for the TVH group were significantly shorter than those of the TAH group （P 〈 0. 05 ）. The hospitalization expense was almost the same in two groups （P 〉 0. 05）. Postoperative complications and the quality of sexual health were not statistically different between two groups at 1 month and 6 months post-operation （P 〉 0.05 ）. The data of three TVH subgroups were collected. The complicated cases with multiple factors group had longer hospitalization duration than the enlarged uterus and the （P 〈 0. 05 ）. Similarly the volume of blood loss in the prior pelvic surgeries/endometriosis history groups complicated cases with multiple factors group was significantly more tha
出处
《中华医学杂志》
CAS
CSCD
北大核心
2014年第15期1173-1175,共3页
National Medical Journal of China
关键词
子宫切除术
阴道式
外科手术
微创性
Hysterectomy,vaginal
Surgical procedures, minimally invasive
