腹腔镜辅助下阴式与腹式全子宫切除术的临床应用比较

摘要

Objective To compare the clinical efficacy of transabdominal hysterectomy ( TAH ) and laparoscopic-assisted vaginal hysterectomy ( LAVH ). Methods A retrospective analysis was made on clinical data of 57 cases of conventional TAH group and 31 cases of LAVH group from January 2008 to December 2010 hospitalized in Central Hospital of Baoji City. The cases could not receive vaginal operation because of much big uterus ( uterine volume = 12gestational weeks ), pelvic adhesion or adnexa diseases. The operating time, intraoperative blood loss,postoperative exhaust time,wound healing and postoperative days of two groups were compared. Results There was no significant difference in patients' age, body weight, size of uterus and past history of abdominal operation between two groups ( t value was 0. 33 , 0. 15 , 0. 95 and 3. 08 , respectively, all P >0. 05 ). The operation time in LAVH group was longer than that in TAH group, but the amount of bleeding was less than that of TAH group ( t =3. 13 and 2. 21 , respectively, both P < 0. 05 ). The exhaust time and defecation time of LAVH group were earlier than those of TAH group ( t value was 6. 91 and 2. 00, respectively, both P < 0. 05 ). In LAVH group 30 patients ( 96. 77% ) had good wound healing and 1 case with vaginal stump wound infection. Whereas in TAH group 51 patients (89.47% ) had good wound healing, 4 cases with poor wound healing, 1 case with wound infection and another 1 case with wound dehiscence partly. There was no significant difference in wound healing rate between two groups (x2 = 0. 63 , P>0.05 ). The length of stay in hospital was shorter in LAVH group than that in TAH group (t=9.30,P<0.05). Conclusion LAVH has advantage of fast postoperative recovery and short hospital stay, but there are still shortcomings in operation time and intraoperative blood loss.%目的 评价腹腔镜辅助下阴式与腹式子宫切除术的临床效果.方法 回顾分析宝鸡市中心医院2008年1月至2010年12月因子宫良性病变需切除子宫,但子宫较大(子宫体积≥12孕周)、盆腔粘连或附件病变不能行阴式手术者.其中行腹腔镜辅助下阴式子宫切除31例为LAVH组,以57例常规行腹式子宫全切除患者为TAH组.对两组手术时间、术中出血量、术后肛门排气时间、伤口愈合情况、术后住院日等进行比较.结果 两组患者年龄(t=0.33)、体质量(t=0.15)、子宫大小(t=0.95)、既往腹部手术史(χ2=3.08)比较,无显著性差异(均P>0.05).LAVH组手术时间长于TAH组(t=3.13,P<0.01),术中出血量少于TAH组(t=2.21,P<0.05).LAVH组术后排气时间和排便时间早于TAH组(t值分别为6.91,2.00,均P<0.05).LAVH组伤口愈合良好30例(96.77%),阴道残端伤口感染1例,TAH伤口愈合良好51例(89.47%),伤口愈合不良4例,伤口感染1例,伤口部分裂开1例.两组伤口愈合率比较无显著性差异(χ2=0.63,P>0.05).LAVH组住院时间短于TAH组(t=9.30,P<0.05).结论 腹腔镜辅助下阴式子宫切除,术后康复快,住院时间短,但手术时间和术中出血量仍存在不足.