【摘要】 目的评价腹腔镜辅助阴式子宫切除术(LAVH)在腹腔镜子宫切除术开展过程中的作用。方法回顾性分析2002年11月￣2005年10月期间该院子宫切除术905例患者的临床资料,按不同术式分为四组。以年为一个时间段,观察各组比例的变化;观察各组并发症及腹腔镜手术中转开腹的例数;比较第1年度Ⅰ组与Ⅱ组的手术时间、术中出血量、术后恢复情况、术后住院天数及住院费用;最后1年各组间进行同样的比较。结果LAVH术式率先开展,其他腹腔镜子宫切除术式开展后,LAVH术式比例减少。LAVH术式无1例并发症,无1例中转开腹。其他术式皆有并发症或中转开腹情况。第1年内Ⅱ组比Ⅰ组手术时间长,术中出血量多,住院费用高,术后肛门排气时间缩短,在术后下床活动时间、术后住院天数两组无差别。最后1年除Ⅱ组的手术时间,Ⅳ组术中出血量与Ⅰ组无差别外,腹腔镜子宫切除各组的住院费用皆高于Ⅰ组,腹腔镜子宫切除各组在其他各个方面皆明显优于Ⅰ组。除腹腔镜子宫切除各组间住院费用无差别外,Ⅱ组在其他各个方面皆不如Ⅲ组,Ⅱ组的手术时间比Ⅳ组长,这两组在其他方面的比较无差别。结论从LAVH入手开展腹腔镜子宫手术,手术成功率高,并发症少,并且可以通过LAVH熟练腹腔镜子宫切除手术技巧,使腹腔镜子宫手术的开展更加顺利。更多还原

【Abstract】 [Objective] To evaluate the role of laparoscope assisted vaginal hysterectomy in the development of laparoscopic hysterectomy. [Methods] We conducted a retrospective analysis on 905 cases of hysterectomy, and divided the patients into four groups by different types of operations: group I:abdominal hysterectomy(AH, 383 cases); group II:Laparoscopic assisted vaginal hysterectomy(LAVH, 215 cases);group III :Laparoscopic subtotal hysterectomy/Classic Intrafascial Semm Hysterectomy(LSH/CISH, 188 cases); group IV: Total laparoscopic hysterectomy (TLH, 119 cases). We compared annually the number of cases in each group, the resulting complications, and cases that received laparoscopic hysterectomy but were switched to abdominal hysterectomy during laparoscopic operations from December 2002 to October 2005. We compared the operation time, blood loss, postoperative recovery, the hospitalization days after the operations and the hospitalization expenses between AH group and LAVH group in the first year. Meanwhile, we repeated the same comparisons in the last year. [Results] LAVH were first developed, and declined after the other laparoscopy types were conducted. There was no complication and no type switching during laparoscopy in LAVH group while other operating types had. Group Ⅱ has longer operation time, larger blood loss during operation, higher expenses, and shorter anus exhaust recovery time after operation than those in groupⅠduring the first year, and other comparisons showed no difference. The operation time in groupⅡ and the blood loss in group Ⅳ did not differ from that in groupⅠ during the last year, each laparoscopy group need higher expenses than that in groupⅠ, and others comparison between each laparoscopy group and groupⅠsuggests that laparoscopy is better. There is no difference about hospitalization expenses among each laparoscopy group, and in others comparison group Ⅲ are better than groupⅡ, and group Ⅳ does not differ from groupⅡexcept operation time, which is short in group Ⅳ. [Conclusions] LAVH is more preferable than others to initiate laparoscopic hysterectomy since it has a high success rate with low complications. Technically, LAVH helps surgeons familiarize the main points in performing laparoscopic hysterectomy, and thus extends the application of it.更多还原