CAJ | 학술논문

目的探讨改良困难阴式全子宫切除术优越性、安全性及可行性.为拓展阴式全子宫切除术适应证提供科学依据.方法回顾分析2009年1月至2012年7月卫生部北京医院妇科因良性病变(非脱垂子宫)行全子宫切除术患者共237例,其中腹式全子宫切除术70例(TAH组),困难阴式全子宫切除术167例(TVH组).TVH组分为3个亚组:大子宫组(宫体＞孕12周)100例、既往盆腔手术史和(或)子宫内膜异位症史组25例、多种困难因素并存组42例.比较两组术中术后及随访情况.结果手术时间、术中出血量及术中输血TVH组分别为(71±5)min、(228±25)ml及7例;TAH组分别为(104±10) min、(363 ±66) ml及11例,两组比较均P＜0.05.手术并发症两组差异无统计学意义.TVH组无中转开腹.TVH组术后发热时间、排气时间、住院时间短于TAH组(均P＜0.05),两组住院费用、术后1及6个月并发症、性生活满意率差异无统计学意义.TVH 3亚组手术时间由长至短依次为多种困难因素并存组、大子宫组及既往盆腔手术史和(或)子宫内膜异位症史(P＜0.05),与手术时间相符,多种困难因素并存组术中出血大于其余两组(P＜0.05).结论改良困难阴式全子宫切除术体现出微创、安全、将操作化繁为简的手术特点,是值得临床推广的实用术式.
목적 탐토개량곤난음식전자궁절제술우월성、안전성급가행성.위탁전음식전자궁절제술괄응증제공과학의거.방법 회고분석2009년1월지2012년7월위생부북경의원부과인량성병변(비탈수자궁)행전자궁절제술환자공237례,기중복식전자궁절제술70례(TAH조),곤난음식전자궁절제술167례(TVH조).TVH조분위3개아조:대자궁조(궁체＞잉12주)100례、기왕분강수술사화(혹)자궁내막이위증사조25례、다충곤난인소병존조42례.비교량조술중술후급수방정황.결과 수술시간、술중출혈량급술중수혈TVH조분별위(71±5)min、(228±25)ml급7례;TAH조분별위(104±10) min、(363 ±66) ml급11례,량조비교균P＜0.05.수술병발증량조차이무통계학의의.TVH조무중전개복.TVH조술후발열시간、배기시간、주원시간단우TAH조(균P＜0.05),량조주원비용、술후1급6개월병발증、성생활만의솔차이무통계학의의.TVH 3아조수술시간유장지단의차위다충곤난인소병존조、대자궁조급기왕분강수술사화(혹)자궁내막이위증사(P＜0.05),여수술시간상부,다충곤난인소병존조술중출혈대우기여량조(P＜0.05).결론 개량곤난음식전자궁절제술체현출미창、안전、장조작화번위간적수술특점,시치득림상추엄적실용술식.
Objective To explore the advantage,feasibility and safety of modified approach to difficult vaginal hysterectomy and provide scientific rationales for expanding its indications.Methods A retrospective study was conducted for 237 patients undergoing hysterectomy for benign disease of uterus (without prolapse) from January 2009 to July 2012.Both modified approach to difficult vaginal hysterectomy (TVH,n =167) and abdominal hysterectomy (TAH,n =70) were performed.Two groups were compared for epidemiological,clinical characteristics,operative duration,intraoperative blood loss volume,perioperative and postoperative complications,hospitalization duration,inflammatory response and follow-up outcomes.TVH was divided into 3 subgroups of enlarged uterus (n =100),prior pelvic surgeries/ endometriosis history (n =25) and complicated cases with multiple factors (n =42).Then the surgical outcome parameters were compared for each group.Results The operative duration,intraoperative blood loss volume and blood transfusion amount were significantly less in the TVH group than those in the TAH group (P ＜ 0.05).No major perioperative complications occurred in either group.There was no conversion from TVH into TAH.Inflammatory response,gastrointestinal recovery and hospitalization duration for the TVH group were significantly shorter than those of the TAH group (P ＜ 0.05).The hospitalization expense was almost the same in two groups (P ＞ 0.05).Postoperative complications and the quality of sexual health were not statistically different between two groups at 1 month and 6 months post-operation (P ＞ 0.05).The data of three TVH subgroups were collected.The complicated cases with multiple factors group had longer hospitalization duration than the enlarged uterus and the prior pelvic surgeries/endometriosis history groups (P ＜ 0.05).Similarly the volume of blood loss in the complicated cases with multiple factors group was significantly more than those of other two groups (P ＜ 0.05).Conclusion As one kind of mini-invasive surgery with less complications,higher safety and feasibility,modified approach to difficult vaginal hysterectomy offers shorter operative duration,less volume of blood loss and faster recovery.