全子宫切除术的三种术式探讨  

Study of Three Different Approach Routes in Hysterectomy

作　　者：沈丹[1] 左艳[1] 闫彩萍[1] 邝国超[1] 

机构地区：[1]暨南大学医学院第三附属医院

出　　处：《肿瘤预防与治疗》2009年第2期149-151,138,共4页Journal of Cancer Control And Treatment

摘　　要：目的：探讨腹式全子宫切除术、阴式全子宫切除术及改良的腹腔镜筋膜内全子宫切除术的临床价值。方法：172例子宫良性疾病,71例行腹式全子宫切除术（A组）、43例行阴式全子宫切除术（B组）及58例行改良的腹腔镜筋膜内全子宫切除术（C组）。对三组患者的手术时间、出血量、术后疼痛程度、肠蠕动恢复时间、保留尿管时间、住院天数、住院费用及随访一年的情况进行分析。结果：C组较A、B组术后疼痛轻,肠蠕动恢复快,保留尿管时间短,离床活动时间早,差异有统计学意义（P〈0.01或0.05）;A、B组之间相比较差异无统计学意义。术后1年随访,C组膀胱功能及性功能在术前、术后无明显改变,较A、B组差异有显著性（P〈0.01或0.05）。A组较B、C组手术时间均短,且差异有显著性（P〈0.01）。C组较A、B组医疗费用高,手术时间长,且差异有显著性（P〈0.01）。结论：三种全子宫切除术各有利弊,随着腔镜技术的发展与改良,腹腔镜筋膜内全子宫切除术的优势更趋明显,是一种较理想的术式。Objective： To evaluate the clinical application of transabdominal total hysterectomy,transvaginal total hysterectomy and pelviscopics EMM hysterectomy. Methods： 172 cases with benign diseases of uterus were divided into 3 groups ：Group A ,transabdominal total hysterectomy in 71cases;Group B, transvaginal total hysterectomy in 43 cases ; and Group C, pelviscopic intrafascial SEMM hysterectomy in 58 cases. The time of operation, volume of bleeding ,intensity of postoperative pain, recovery time of intestinal peristalsis, time of urinary canal reservation, duration and cost of hospitalization as well as the patient＇ s status during one year follow-up were compared among these three groups. Results： Patients in Group C displayed mild postoperative pain, earlier recovery of intestinal peristalsis and earlier rehabilitation, with shorter time reservation of urinary canal compared with Groups A and B （ P 〈 0.01 and 0.05 ）. No significant difference was found in those index between Group A and B. The function of urinary bladder and sexual funcition in pa- tients of Group C showed no distinct discrepancy before and after operation, and the difference were significant comparing with those of Groups A and B （P〈0.01 or 0.05）.The time of operation in Group A was shorter than those of Greups B and C（P〈0.01）, expensive cost of hospitalization and longer time of operation were recorded in Group C when it was compared with other two groups （ P 〈 0. 01 ）. Conclusion： Three types of hysterectomy have their own advantages and disadvantages separately. With the development of laparoscopic technology, the superiority of pelvicopie intrafascial SEMM hysterectomy becomes obvious.

关 键 词：子宫切除术/方法 腹部 全子宫切除术 阴道术 外科手术 腹腔镜 

分 类 号：R713.42[医药卫生—妇产科学]