腹腔镜辅助阴式与开腹大子宫全切术的比较

摘要

Objective To investigate the operating skills and efficacy of laparoscopic -assisted vaginal hysterectomy (LAVH) for huge uterus. Methods A retrospective analysis was made on 96 cases of huge uterus (12 - 20 gestational weeks). Among the patients, total abdominal hysterectomy (TAH) was performed on 51 cases, and the other 41 cases received LAVH. The operation time, intraoperative blood loss, and postoperative recovery time of gastrointestinal function, rate of analgesia provision, and hospital stay were compared between the two groups. In LVAH group, a trocar was placed at 1- to 4-cm above the umbilicus, and LigaSure vessel sealing system was used to cut the isthmus of fallopian tubes, ovarian inherent ligaments or suspensory ligaments, and uterine round ligaments. Subserosal myoma that interfered with the operation and broadly ligament myoma were resected after injecting 6U of pituitrin around the uterine muscles. Results Operation time showed no significant difference between the two groups [( 106. 4 ± 18. 9) min vs. (102. 5 ± 12. 1) min, t = - 1.218, P = 0-.226 ]. LAVH groups showed less intraoperative blood loss, shorter recovery time of gastrointestinal function, lower rate of analgesia provision, and shorter postoperative hospital stay than the TAH group [ (119. 8 ± 31.1) ml vs. (139.8 ±33.3) ml, t= -3.029, P =0.003; (23.8 ±11.1) h vs. (31.4 ± 13. 1) h, ( = -3.045, P= 0.003; 4.4% (2/45) vs. 100% (51/51),P=0.000; (4.7±0.3) d vs. (8.0±1.3) d, t= -16.633, P=0.000]. Conclusion LAVH is effective and worth being widely used for huge uterus for its quick recovery and low rate of complications after the operation.%目的 探讨大子宫(≥12孕周)良性肿瘤行腹腔镜辅助阴式全子宫切除术的临床应用价值. 方法 回顾性分析我院2009年1月～2011年12月96例因子宫良性病变致子宫增大至12 ～20孕周行子宫全切术的临床资料,其中51例行开腹全子宫切除术(TAH组),45例行腹腔镜辅助阴式全子宫切除术(LAVH组),比较2组手术时间、术中出血量、术后排气时间、术后镇痛率、住院时间.LAVH手术主要步骤:镜头穿刺点的位置选择脐孔上方1～4 cm处,结扎速血管闭合系统电凝切断输卵管峡部、圆韧带、卵巢固有韧带或骨盆漏斗韧带,有盆腔粘连者予以分离,对于阔韧带肌瘤或影响操作的浆膜下子宫肌瘤,于肌瘤周围组织内注射垂体后叶素6U,予以剔除.子宫血管经阴道手术时处理. 结果 LAVH组与TAH组手术时间无统计学差异[(106.4±18.9) min vs.(102.5±12.1)min,t=-1.218,P=0.226],LAVH组术中出血量少[(119.8±31.1)ml vs.(139.8±33.3)ml,t=-3.029,P=0.003]、术后排气早[(23.8±11.1)h vs.(31.4±13.1)h,t=-3.045,P=0.003]、住院时间短[(4.7±0,3)d vs.(8.0±1.3)d,t=-16.633,P=0.000]、术后镇痛率低[4.4％ (2/45) vs.100％(51/51),P=0.000]. 结论 大子宫良性病变行LAVH安全可靠,具有术后恢复快,并发症少等优点,值得在临床上推广应用.