改良大子宫腹腔镜辅助阴式切除术的临床研究(1)
 |
| 第1页 |
参见附件(2179KB，3页)。
【摘要】 目的 比较大子宫阴式切除术(TVH)与改良腹腔镜辅助下大子宫(子宫如孕12~20周)阴式切除术(LAVH)的临床效果。方法 收集该院2006年1 月至2009年6月接受不同途径大子宫切除术患者(170例)的临床资料,其中阴式大子宫全切除术78例(阴式组),改良腹腔镜辅助大子宫阴式全切除术92例(腹腔镜组),比较两组的手术时间、术中出血量、术后恢复情况。结果 与TVH组相比,LAVH组中转开腹率低(0/92 vs 6/78,χ2=5.25,P<0.05),手术时间短[(138±12.2)min vs(172±14.6)min,t=16.54,P<0.01],术后住院时间短[(5.6 ±1.3)d vs(7.8 ±3.5)d,t=5.60,P<0.01]。两组术中出血量、术后病率、术后排气时间差异无显著性(P>0.05)。结论 LAVH扩大TVH的适应证,使大于孕12周子宫切除能在微创手术下顺利完成,是值得推广的手术方法。
【关键词】腹腔镜辅助阴式子宫切除术;大子宫;子宫切除
Clinical study of big uterus reforming laparoscopcally assisted vaginal hysterectomy
XIN Feng,ZHAO Yan-mei,GENG Ai-zhi.Department of Obstetrics and Gynecology,the Second’s Hospital of liaocheng,Shandong252600,China
【Abstract】 Objective To compare clinical result of through vaginal hysterectomy(TVH)and modified laparoscope assisted vaginal hysterectomy(LAVH)for big uterus.Methods 170 cases of big uterus hysterectomy through vaginal or assisted vaginal hysterectomy from Jan 2006 to July 2009 were collected in our hospital.There were78 through vaginal hysterectomies(TVH groups)and 92 reforming laparoscope assisted vaginalhysterectomies(LAVH groups).operation time,bleeding volume and postoperative recovery of the patients were studied and compared between two groups.Results Compared with TVH group,there was a lower chance of abdominal hysterectomy(0/92 vs 6/78,χ2=5.25,P<0.05),a shorter operation time[(138±12.2)min vs(172±14.6)min,t=16.54,P<0.01]and a shorter postoperative hospital stay[(5.6 ±1.3)d vs(7.8 ±3.5)d,t=5.60,P<0.01]in the LAVH group.There were no significant differences in blood loss,morbidity and time to first flatus between the two groups.Conclusion The LAVH extends the indications ofTVH,ensuring the safety of TVH for the uterus is bigger than that of 12 gestational weeks,therefore it is an operative procedure to be recommended.
【Key words】Laparoscopic-assisted vaginal hysterectomy; Big uterus; Hysterectomy
进入21世纪,微创外科将成为妇科发展的主流。不同的微创手术入路在各地普遍被应用于子宫切除中,改变了传统妇科疾病的诊断和治疗模式。阴式手术(trans vaginal hysterectomy,TVH)及腹腔镜(total laparoscop ic hysterictomy,TLH)手术均具有创伤小、出血少、时间短、痛苦小、恢复快等优点,同时避免了开腹手术(total abdom in hysterectomy,TAH)对患者身体和精神造成的不良影响。尤其TVH被认为是最微创、最符合循证医学原则的手术方式[1]。但对于大于12孕周的子宫无论经阴道(TVH)及腹腔镜(TLH)手术,都存在一定的困难。为此,我们在成功开展了大子宫阴式子宫切除术及腹腔镜子宫切除术的基础上,借助电外科器械、阴式手术器械的发展,对子宫大于12孕周的患者开展腹腔镜辅助阴式子宫全切除术(laparoscopically assisted vahinal hysterectomy,LAVH),并对部分手术步骤进行改良,收到了良好效果。现将结果报告如下。
1 资料与方法 ......
您现在查看是摘要介绍页，详见PDF附件(2179KB，3页)。