【摘要】 目的:研究经腹全子宫切除术(TAH)、非脱垂式阴式全子宫切除术(TVH)、腹腔镜全子宫切除术(LTH)、腹腔镜辅助下阴式全子宫切除术(LAVH)不同术式全子宫切除的临床效果。方法:回顾分析2006年7月~2012年9月该院259例全子宫切除的临床资料,其中TAH组110例、TVH组74例,LTH组35例、LAVH组40例,对照分析四种术式的术中出血量、手术时间、术后肛门排气时间、术后住院天数,术后镇痛率、住院费用。结果:四组患者术中出血量比较:LTH组>LAVH组>TAH组>TVH组,分别为:(310±39.58)ml、(138±13.95)ml、(107±12.03)ml、(60±6.75)ml,差异有统计学意义(P<0.01);四组患者手术时间比较:LTH组>LAVH组>TAH组>TVH组,分别为:(137±13.46)min、(89±14.81)min、(74±4.43)min、(73±4.7)min,LTH组与LAVH组、TVH组、TAH组比较,差异有统计学意义(P<0.01),TAH组手术时间与TVH组相当,比较差异无统计学意义(P>0.05)。四组患者的术后肛门排气时间:TAH组>LAVH组>LTH组>TVH组,分别为:(45±5.43)h、(26±1.17)h、(23±1.74)h、(13±1.38)h,差异有统计学意义(P<0.01);四组患者的术后住院天数比较:TAH组最长,与LAVH组、LTH组、TVH组比较,差异有统计学意义(P<0.01),但LAVH组与LTH组比较差异无统计学意义(P>0.05)。四组患者的术后镇痛率比较,TAH组>LTH组>LAVH组>TVH组,差异有统计学意义(χ2=36.340,P=0.000 0);四组患者的住院费用比较:TVH组最低,与LAVH组、LTH组、TAH组比较,差异有统计学意义(P<0.01);LTH与LAVH组比较差异无统计学意义(P>0.05)。结论:四种子宫全切除术各具有优点和不足之处,各有其适应证和禁忌证,医师在选择术式时应做多方面综合考虑,以便取得最佳临床治疗效果,LTH值得临床推广使用。更多还原

【Abstract】 Objective: To research the clinical effects of transabdominal total hysterectomy( TAH),transvaginal total hysterectomy( TVH),laparoscopically total hysterectomy( LTH) and laparoscopic assisted vaginal hysterectomy( LAVH). Methods: The clinical data of 259 patients undergoing total hysterectomy from July 2006 to September 2012 were analyzed retrospectively,including 110 patients in TAH group,74 patients in TVH group,35 patients in LTH group and 40 patients in LAVH group; the amounts of intraoperative blood loss,operation times,postoperative times for anal exhaust,postoperative hospitalization times,postoperative analgesia rates and hospitalization costs in the four groups were compared and analyzed. Results: Comparison of the amount of intraoperative blood loss: LTH group > LAVH group >TAH group > TVH group,the amounts of intraoperative blood loss in LTH group,LAVH group,TAH group and TVH group were( 310 ±39. 58) ml,( 138 ± 13. 95) ml,( 107 ± 12. 03) ml and( 60 ± 6. 75) ml,respectively,there was statistically significant difference among the four groups( P < 0. 01). Comparison of operation time: LTH group > LAVH group > TAH group > TVH group,the operation times in LTH group,LAVH group,TAH group and TVH group were( 137 ± 13. 46) minutes,( 89 ± 14. 81) minutes,( 74 ± 4. 43) minutes and( 73 ±4.7) minutes,respectively,there was statistically significant difference between LTH group and LAVH group,TVH group,TAH group( P < 0. 01),but there was no statistically significant difference between TAH group and TVH group( P > 0. 05). Comparison of postoperative time for anal exhaust: TAH group > LAVH group > LTH group > TVH group,the postoperative times for anal exhaust in TAH group,LAVH group,LTH group and TVH group were( 45 ± 5. 43) hours,( 26 ± 1. 17) hours,( 23 ± 1. 74) hours and( 13 ± 1. 38) hours,respectively,there was statistically significant difference among the four groups( P < 0. 01). Comparison of postoperative hospitalization time: the postoperative hospitalization time in TAH group was the longest,compared with LAVH group,LTH group and TVH group,there was statistically significant difference( P < 0. 01),but there was no statistically significant difference between LAVH group and LTH group( P >0.05). Comparison of postoperative analgesia rate: TAH group > LTH group >LAVH group >TVH group,there was statistically significant difference among the four groups( χ2= 36. 340,P = 0. 000 0). Comparison of hospitalization cost: hospitalization cost in TVH group was the lowest,compared with LAVH group,LTH group and TAH group,there was statistically significant difference( P < 0. 01),but there was no statistically significant difference between LTH group and LAVH group( P > 0. 05). Conclusion: The four surgical methods have their own advantages,disadvantages,indications and contraindications,all aspects should be considered when doctors choose surgical method to obtain optimal clinical curative effect,TLH is worth popularizing and applying in clinic.更多还原