中华妇幼临床医学杂志(电子版) ›› 2011, Vol. 07 ›› Issue (06) : 552 -554. doi: 10.3877/cma.j.issn.1673-5250.2011.06.009 × 扫一扫
论著
出版日期:
Lian-min ZHANG, Xu ZHAO
Published:
Supported by:
张连民, 赵旭. 对子宫大小超过孕龄12孕周患者的3种微创手术临床效果分析[J]. 中华妇幼临床医学杂志(电子版), 2011, 07(06): 552-554.
Lian-min ZHANG, Xu ZHAO. Clinical Effects Analysis of Three Minimally Invasive Surgery Procedures for Hysterectomy With Large Uterus: Size More Than 12 Pregnant Weeks[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2011, 07(06): 552-554.
探讨改良开腹子宫全切除术(MTAH)、腹腔镜下子宫全切除术(TLH)和经阴道子宫全切除术(TVH)在子宫大小超过孕龄12孕周切除术中的应用。
回顾性分析2009年1月至2011年1月在本院因子宫肌瘤行子宫全切除术(子宫大小超过孕龄12孕周)的88例患者的临床病历资料。将其按照3种不同术式分为：MTAH组(n＝36)，TLH组(n＝28)和TVH组(n＝24)。分析各组手术时间、术中出血量、抗菌药物使用时间、并发症发生率、肛门排气时间、住院时间和住院费用，比较各组术中和术后情况 (本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准，得到该委员会批准，分组征得受试对象本人的知情同意，并与之签署临床研究知情同意书)。3组患者年龄、拟切除子宫大小及手术操作(相同医生)等比较，差异无统计学意义(P>0.05)。
手术时间、术中出血量和住院费用比较，TLH组分别长于、多于和大于另外两组，差异有统计学意义(P<0.05)；而MTAH组和TVH组比较，差异无统计学意义(P>0.05)。抗菌药物使用时间比较，MTAH组长于另外两组，差异有统计学意义(P<0.05)；而TLH组和TVL组比较，差异无统计学意义(P>0.05)。3组并发症发生率、肛门排气时间和住院时间比较，差异无统计学意义(P>0.05)。
对于子宫大小超过孕龄12孕周患者的子宫切除术，MTAH, TLH和TVH 3种术式各具优势，且不可互相替代，应结合患者自身情况、医疗条件和技术水平等综合考虑，尽量选择微创和经济的术式。
To investigate clinical effects of modified total abdominal hysterectomy (MTAH), total laparoscopic hysterectomy (TLH) and trans-vaginal hysterectomy (TVH) on large uterus hysterectomy.
The retrospectively analysis were conducted on 88 cases who were underwent hysterectomy with size more than 12 pregnant weeks from January 2009 to January 2011. They were divided into three groups, MTAH group (n=36), TVH group (n=24) and TLH group (n=28). Operation time, bleeding volume, antibiotic administration time, rates of complications, bowel function recovery time, hospital-duration, hospital-cost, and pre- and post-operation effects were compared. Informed consent was obtained from all participates. There had no significant difference among three groups of age and operative procedure (same operation performer) (P>0.05).
The operation time, bleeding volume and hospital-cost in TLH group were more than those in TVH group and MTAH group with significant differences (P<0.05), without significant differences between those in TVH group and MTAH group (P>0.05). The antibiotic administration time in MTAH group was more than that in TVH and TLH groups with significant differences (P<0.05), without significant difference between that in TVH group and TLH group (P>0.05). The incidence rate of complications, bowel function recovery time and hospital-duration among three groups had no significant differences (P>0.05).
Three different operation procedures for total hysterectomy with size more than 12 pregnant weeks uterus have their own advantages and disadvantages. Considering the different condition of patients, hospital and technical levels, microinvasive and economical surgery should be chosen.