经阴道前穹窿 经阴道后穹窿 阴道前后穹窿全打开三种入路行筋膜内阴式子宫全切除术的比较  

作　　者：李阳敏 罗义 陈继泽 杨红春 魏成刚 

机构地区：[1]四川省南充市中心医院妇科,637000

出　　处：《浙江临床医学》2016年第12期2262-2264,共3页Zhejiang Clinical Medical Journal

摘　　要：目的探讨经阴道前穹窿、经阴道后穹窿、阴道前后穹窿全打开三种入路方式在筋膜内阴式子宫全切除术中的应用，对三种方法进行比较。方法回顾性分析600例筋膜内阴式子宫全切除术患者资料，其中368例使用经阴道前穹窿入路，127例用经阴道后穹窿入路，105例使用阴道前后穹窿全打开入路。比较三组入路方式平均手术时间、术中平均失血量、术后疼痛发生率和术后阴道T型24h引流量，阴道T型引流管留置时间。微荞线用量及化线反应，术后功能、体温变化，术后并发症。结果手术切除时间，术中出血，术后疼痛发生率和术后24h引流量，阴道T型引流管留置时间，微荞线用量及化线反应，术后并发症，经阴道前穹窿组明显少于阴道后穹窿组，二者又少于阴道前后穹窿全打开组，且差异有统计学意义（P〈0．05或P〈0．01）。结论三种入路方式在筋膜内阴式子宫全切除术中切除效果及对术后功能、体温影响无明显差异。但应用经阴道前穹窿入路，手术时间最少，术后恢复快且手术副反应小，阴道前后穹窿全打开入路视野最为宽阔，但失血最多，时间最长，且手术副反应最大。Objective To investigate the vaginal vault before and after vaginal fornix, the three approach of completely opening vaginal vaultby intral-faseia vaginal total uterus resection; Methods A retrospective analysis of 600 patients undergoing intra-fascial aginal total uterus resection -was performed, inoluding 368 cases using the anterior approach through vaginal vault, 127 cases with posterior approach through vaginal vault, 105 cases with total opening of vaginal vault with combined anterior anti posterior approaches. Comparing three groups in the resection part, postoeperative function and temperature, there is no difference amongthe three approaches. But the anterior approach takes the least operative time with a quicker recovery and less side effects, while the posterior approach has a most broadened vision on the sacrifice of the most volume of bleeding and longest operation time, as well as more side effects surgically. Results Surgical removal of the time, intraoperative bleeding, the incidence of postoperative pain and postoperative 24 h flow, vaginal T drainage tube indwelling time, dosage of micro Qiao line and line reaction, postoperative complications, the vaginal vault before group significantly less than the vagina fornix, and both before and after less than vaginal vault full open group, and the difference was statistically significant （ P〈0.05 or P〈0.01 ） . Conclusion Three methods into the road within the fasciaYin type uterus resection in the whole effect and influence on postoperative function, body temperature, no obvious difference. But before the application of transvaginal vault into the road, least time surgery, postoperative recovery quickly and side reaction is small, the operation of vaginal vault before and after the most wide open in the vision, but the loss of blood, most, longest, and the operation side effects is the largest.

关 键 词：经阴道穹窿 筋膜内阴式子宫全切除术 切除效果功能 副反应 

分 类 号：R713.42[医药卫生—妇产科学]