腹腔镜筋膜内子宫切除与阴式全子宫切除术对比分析

摘要

目的：对比分析腹腔镜筋膜内子宫切除(LIH)与非脱垂阴式全子宫切除(TVH)的临床效果,探讨临床适用性及改善手术效果的可行性。方法随机选择该院2012年10月—2014年10月收治的有子宫切除指征的患者156例(A组),行LIH,同时期具备类似手术指征的非脱垂子宫130例(B组),行TVH,观察术中出血量、手术时间,术后肩痛、腹胀发生率、肛门排气时间、手术费用、住院天数及并发症情况。结果 A组术中出血量(50.5±5.5)mL少于B组(200.6±30.5)mL,腹胀26.9%大于B组8.6%,肩痛32.7%大于B组,A组平均住院费用12056.5元大于B组6576.8元,均差异有统计学意义(P<0.05)；手术时间[A组(76.4±10.5)min,B组(85.2±5.1)min]、肛门排气时间[A组(26.5±3.3)h,B组(25.8±5.4)h]、住院时间[(A组(7.2±1.2)d,B组(7.6±1.8)d],均差异无统计学意义(P>0.05)；A组输尿管损伤1例,皮下气肿1例,子宫峡部残端出血1例,B组膀胱损伤1例,1例右侧附件脓肿。结论二者均为微创手术,术后恢复快,TIH出血少,随着阴式手术器械的改进,术中出血量将进一步减少,手术时间进一步缩短,二者各有优缺点,应针对手术适应症,根据患者意愿及手术者技术熟练程度,选取手术方式,二者皆值得推广。%Objective To compare the clinical effect of laparoscopic fascia hysterectomy (LIH) and non prolapse transvagi-nal hysterectomy (TVH), to explore the feasibility of clinical application and to improve the effect of surgery. Methods Ran-domly selected in our hospital in October 2012 to October 2014 from hysterectomy refers to 156 patients (group A), LIH, at the same time have similar surgical indications of non prolapsed uterus in 130 cases (group B), TVH,The amount of bleed-ing, operation time, the incidence of postoperative shoulder pain, abdominal distension, anal exhaust time, operation cost, hospital stay and complications were observed. Results The bleeding volume of A group(50.5±5.5)mL was less than that in group B (200.6±30.5)mL, 26.9% higher than that of group B abdominal distension 8.6%, shoulder pain 32.7% higher than that of B group, the average hospitalization expenses of 12 056.5 yuan more than 6 576.8 yuan in B group, were statistically significant (P< 0.05); operation time [A group (76.4±10.5)min, B group (85.2±5.1)min], anal exhaust time [A group (26.5 ±3.3)]h, B group [(25.8±5.4)h], the hospitalization time [A group (7.2±1.2)days, B group(7.6±1.8)days], had no statistical significance (P>0.05);A group 1 cases of ureter injury, 1 cases of subcutaneous emphysema, 1 cases of pelvic stump hem-orrhage, 1 cases of B group bladder injury, 1 cases on the right side of accessory abscess. Conclusion The two are mini-mally invasive, rapid postoperative recovery, less bleeding TIH, with improved vaginal surgical instruments, intraoperative blood loss of TVH will be further reduced, the operation time is further shortened, the two have different advantages and disadvantages, should be according to the indications for surgery, according to the wishes of patients and the operation of skilled degree of selection the operation mode, the two are worthy of promotion.