【作者】 王霞；

【导师】 李莉；

【作者基本信息】 山西医科大学 ， 妇产科， 2002， 硕士

【摘要】 [目的]探讨综合评分法在指导阴式子宫切除术(TVH)的应用价值。[方法]1、选择1998年1月～1999年10月住院病人中101例因子宫病变为指征需行子宫全切术的患者，除去社会因素、恶性肿瘤、阴道狭窄(窄于二横指)、子宫脱垂、合并附件肿瘤直径＞6cm及盆腔有严重粘连者。2、运用单因素和多因素LOGISTIC回归分析方法，对所有与子宫切除途径相关的因素进行分析(a=0.05)，筛选出主要相关因素并建立判别模型，设定评分法，比较模型与评分法预测手术途径的符合率。3、运用ROC曲线和有序样品聚类法确定最有意义的评分截断点，依此将所有病例分组。比较各组的手术结局、手术时间、出血量、并发症率、住院日等指标。[结果]1、与子宫切除途径相关的因素是子宫大小、子宫下移度、子宫位置、阴道宽度，模型判别总符合率为95.1％，评分判别总符合率为92.1％两者比较无统计学差异，x~2=0.742，P=0.390，2、根据最佳截断点，把病例分为0～3分、4～5分、6～8分3个组，全部病例的阴式切山岌盯医科J悦学祠皿d七学勺比今仑j仁除率为79 .2%，其中。一3分组29例，有8例经阴道切除，阴式切除率低于后两组，并发症率大于后两组，手术时.间、出血量大于6一8蜀窿且，差异显著(P<0 .05)，刹汽时间、术后止痛率、住院日3组间无差异;4分以上全部经阴道切除，4一5乡如组(31例)与6一8分组(41例)比较，前者出血量、手术时间大于后者，差异有显著性(P<0 .05)，其它指标均无显著胜差异(P>0 .05)。[结论](i)和子宫切除途径相关的主要因素为子宫大小、子宫下移度、子宫位置、阴道宽度4个指标。(2)依此设立的综合评分可以瑟靓组手术途径，代表经阴道手术的难易程度:6一84一5分组需有一定经验的手术刁姐完成，0一3贪窿且手术困难，经腹部手术较安全。更多还原

【Abstract】 [Objective] Formulate the preoperative assessment of transvaginal hysterectomy (TVH). [Methods] 1.Practice over 2 years was studied. Patients with prolaps, melignancy, narrow vagina, in combination with overia tumour larger than 6cm and pelvic serious adhesion were excluded. The mean age of the patients was 45.56 years.2.Sift the main factors associate with the operative approach by Logistic regression analysis and found the discriminant model. Set the comprehensive score based on this model and calculate the coincidence rate of forcaste operative approach.3.Classify the cases by ROC curve and cluster analysis and compare each group’s operation outcomes. [Results] l.the main factors associate with the operative approach were uterus size, uterus descend remove, uterus position and vagina width. Coincidence rate of discriminant model was 95.1% and grade model was 92.1%. There was no significant difference found between two models. 2.Patients were stratified into three groups according to the interrupt point, there was no significant difference found in the postoperative acetanilide rate, intestines functionrecover time, length of postoperative hospital stay among three groups, Patients in group I (grade 0-3 score) had a significant lower transvaginal cut rate and higher complications rate than that of group II (grade 4-5 score)and group III(grade 6-8score).The operation time and blood loss in group I was significantly higher than that in group III .The transvaginal cut rate was 100% both in group II and III. The operation time and blood loss in group II were significantly higher than that in group III,while ,there was no significant difference in other aspects.[Conclusion] (1) The main factors associate with the approach of TVH were uterus size, uterus descend remove, uterus position and vagina width. (2)comprehensive score was useful in selecting the operative approach to hysterectomy: Patients in group III (grade 6 -8score)were easy to be operated and were fit to a new hand. Cases in group II need a skilled operation team .abdominal operation was a safer approach to the patients in group III(grade 6-8score).更多还原