阴式子宫切除术安全性可行性研究  

The feasibility of widened indications for transvaginal hysterectomy

作　　者：李春东[1] 任东平[1] 刘华平[1] 杨琳[1] 

机构地区：[1]空军总医院妇产科,北京100036

出　　处：《空军总医院学报》2005年第1期3-6,共4页Journal of General Hospital of Air Force,PLA

摘　　要：目的探讨拓展经阴道子宫切除适应证的安全性及可行性。方法选择解放军总医院1998年12月至2001年12月期间417例阴式子宫切除的病例(腹式子宫切除术200例为对照组),对阴式子宫切除手术指征、手术时间、出血量、术时副损伤、术后病率及并发症进行回顾性分析。结果单纯阴式子宫切除术242例;同时行双侧附件切除36例;单侧附件切除22例,输卵管切除12例,卵巢囊肿剥除术25例;阴道前后壁修补术73例;子宫内膜异位症14例,其中3例因子宫内膜异位侵及直肠肌层,行直肠前壁病灶切除及直肠前壁修补术。术时副损伤1例,系子宫内膜异位症重度粘连,缝线穿过右侧输尿管致输尿管瘘,术后发现行输尿管膀胱移植术。同时行阴腹联合手术切除子宫附件4例。其中切除残余宫颈附件1例。术后并发症2例,1例为部分阴道壁粘连,1例为下肢静脉血栓。手术时间12～135min,平均51.74±30.62min,术中出血量20～500ml,平均97.77±88.37ml,术前血红蛋白118.63g/L,术后血红蛋白116.28g/IL(P=0.10997≥0.05),术后住院天数4～28d,平均6.6d,术后病率4.83%,均优于腹式子宫切除术组。术后三个月定期随诊,无远期并发症发生。结论经阴道切除无脱垂子宫是有效可行及安全的,但手术的成功率与子宫大小、形态、活动度、盆腔粘连程度及术者技术经验等有关。Objective To assess the outcome of the widened indications for transvaginal hysterectomy in clinical practice. Methods Retrospective analysis of 417 cases underwent transvaginal hysterectomy in our hospital between Dec. 1998 and Dec. 2001. Indications, operative duration, operative blood loss, operative injures, morbidities and complications were evaluated. Results Among the 417 patients, 242 patients received transvaginal hysterectomy alone, the other 175 patients received transvaginal hysterectomy along with other procedures: bilateral appendices resections (36) , one side appendices resections (22) , fallopian-tube resections (12), ovarian cyst resections (25), repairs of anterior and posterior vaginal wall (73) , endometriosis (14) in which 3 patients had infiltration of rectal muscle underwent repairs of the anterior rectal wall, 1 accidental ureter injury owing to the severe adhesion of the endometriosis subsequently underwent ureter-bladder implantation and recovered well, only 4 patients underwent hysterectomy though abdominal and vaginal approaches. There were two post-operative complications: 1 case of adhesion of partial vaginal wall, the other suffered from deep vein embolism of the lower extremities. The mean operative time was 51. 74±30. 62 min (range from 12 to 240 min). The average blood loss was 97. 77±88. 37 ml (range from 20 to 500 ml). Pre-operative hemoglobin was 118.63 g/L, post-operative hemoglobin was 116. 28 g/L (P = 0. 109 97≥0. 05). The mean post-operative hospital stay was 6. 6 days (range from 4 to 28 days). The morbidity rate was 4. 83%. There were no late post-operative complications during the 3 months post-operative follow-up period. Conclusion Vaginal hysterectomy for patients with enlarge uterus, previous pelvic operations and pelvic endometriosis is a safe and effective procedure.

关 键 词：子宫切除术 阴道式 

分 类 号：R713.42[医药卫生—妇产科学]