不同术式子宫切除术临床效果比较分析.docVIP

不同术式子宫切除术临床效果比较分析 　 作者：邓海燕 冯笑丰 莫奕彩 邱伟 【摘要】 目的 分析比较不同术式子宫切除术的临床效果。方法 将227 例子宫切除术患者按不同术式分为腹式子宫切除术(TAH)组78例、腹腔镜子宫切除术(MAH)组54例、阴式子宫切除术(TVH)组32例，腹腔镜辅助阴式子宫切除术(LAVH)组63例；对4组术式的手术时间、出血量、肛门排气时间、住院时间、住院费用等情况进行比较。结果 平均手术时间：LAVH组及TAH组比MAH组及TVH组延长；平均出血量：TAH组比其他3组显著增多；术后肛门排气时间：TAH组比其他3组延长；平均住院时间：TAH组及MAH组长于TVH组和LAVH组；平均住院费用：LAVH组显著高于其他3组。结论 4种术式各具优缺点，不能互相替代，术式选择要根据术者技术水平、医院设备条件、患者病变特点及经济承受能力和意愿等综合考虑。 【关键词】 子宫疾病； 子宫切除术； 分析 【Abstract】 Objective To analyze and compare the clinical effects of different means for hysterectomy. Methods 227 patients underwent hysterectomy were divided into 4 groups according to different operations, which are TAH group, MAH, TVH and LAVH. Comparisons were made among the 4 groups on the operation time, bleeding volume, anal exhaust time, hospitalization time and hospitalization expense. Results The mean operation time in LAVH group and TAH was longer than MAH and TVH. The mean bleeding volume in TAH group was obviously increased. The mean anal exhaust time in TAH group was longer than other groups.The mean hospitalization time in TAH group and MAH was longer than other groups.The mean hospitalization expense in LAVH group was much higher than other 3 groups. Conclusion The four operative means have their own advantages and disadvantages, and can?t be replaced each other.The operative means should be selected according to the comprehensive factors. 【Key words】 Uterine diseases；Hysterectomy；Analysis 传统子宫切除术式有腹式子宫切除术(TAH)和阴式子宫切除术(TVH)，近年来随着内镜技术的发展，又诞生了腹腔镜子宫切除术(MAH)和腹腔镜辅助阴式子宫切除术(LAVH)。为进一步探讨子宫切除术式选择的最佳临床效果，我们于2003年1月～2007年10月对采用4种不同术式的手术效果进行了比较，现总结如下。 1 资料与方法 1.1 对象及分组 选择子宫全切除手术指征明确、子宫体积＜12孕周、子宫活动且无盆腔粘连、无附件疾患及恶性生殖道肿瘤患者227例，其中单纯子宫肌瘤131例，单纯子宫腺肌病69例，子宫肌瘤合并子宫腺肌病18例，功能失调性子宫出血9例。按手术方式不同分为TAH组78例，MAH组54例，TVH组32例和LAVH组63例。4组患者平均年龄、体重、子宫体积、妊娠和分娩次数等比较差异不显著，具有可比性（P＞0.05）。 1.2 麻醉、体位及手术方法 采用全身或连续硬膜外阻滞麻醉。体位：TVH和LAVH组取膀胱截石位，TAH、MAH组取平卧位。TAH、TVH和LAVH组手术过程按常规进行［1，2］。MAH组在耻骨联合上二横指处两端向上作横弧形切口约6～8 cm［2］，如子宫体积大可先牵引子宫一侧至切口，处理卵巢固有韧带、输卵管和骨盆漏斗韧带，子宫残端缝扎止血，并钳夹同侧子宫动、静脉后放回子宫；再牵引子