目的探讨既往有盆腹腔手术史的非脱垂子宫患者经阴道切除子宫(TVH)的可行性。方法佛山市妇幼保健院1992年6月至2003年6月经阴道切除既往有盆腹腔手术史的非脱垂子宫833例(研究组),随机抽取同期子宫大小、分娩史等相似的无盆腹腔手术史800例TVH病人为对照组,从手术质量指标上进行对比分析。结果研究组中除3例中转开腹手术外,余830例均手术成功,21.4%(179/833)术中发现有不同程度的粘连,其中剖宫产术后粘连占36.8%(66/179),附件手术后粘连占10.1%(18/179),阑尾切除术后粘连占11.7%(21/179),子宫肌瘤剔除术后粘连占20.0%(35/179),输卵管结扎术后粘连占21.7%(39/179)。研究组0.60%(5/833)术中出现副损伤,对照组为0.37%(3/800)(P<0.05)。两组手术时间、术中出血量分别为(58±10.6)min和(39±13.2)min;(228±60)mL和(159±57)mL(P<0.01)。两组术后病率和术后住院天数差异无显著意义(P>0.05)。结论有盆腹腔手术史不是TVH的绝对禁忌证,但有两次盆腹腔手术史及术前检查提示严重粘连者,则以腹腔镜辅助阴式子宫切除术(LAVH)或开腹手术为宜。两组术后病率和术后住院天数无明显差异,病人术后恢复仍能体现阴式手术的优点。 Objective To investigate the feasibility of vaginal hysterectomy (TVH) in non-prolapsed uterus with a history of pelvic surgery. Methods Foshan Maternal and Child Health Hospital from June 1992 to June 2003 transvaginal resection of the past history of abdominal surgery with non-prolapsed uterus 833 cases (study group), randomized at the same period the size of the uterus, childbirth and other similar non-abdominal surgery The history of 800 cases of TVH patients as control group, the quality of surgery from the comparative analysis. Results In the study group, except for 3 cases of laparotomy, the remaining 830 cases were successfully operated, and 21.4% (179/833) were found to have different degrees of adhesions. Among them, 36.8% were cured after cesarean section (66/179 ), Posterior adhesions accounted for 10.1% (18/179), appendicectomy adhesions accounted for 11.7% (21/179), myomectomy adhesions accounted for 20.0% (35/179), tubal ligation Accounting for 21.7% (39/179). In the study group, 0.60% (5/833) showed minor injury during operation, which was 0.37% (3/800) in the control group (P <0.05). The operative time and intraoperative blood loss were (58 ± 10.6) min and (39 ± 13.2) min, (228 ± 60) mL and (159 ± 57) mL (P <0.01) respectively. There was no significant difference between the two groups in postoperative morbidity and postoperative hospital stay (P> 0.05). Conclusions The history of pelvic abdominal surgery is not an absolute contraindication to TVH. However, with the history of pelvic and abdominal surgery twice before surgery and the severe adhesion before surgery, laparoscopic assisted vaginal hysterectomy (LAVH) or laparotomy is appropriate. There was no significant difference between the two groups in the postoperative morbidity and the number of postoperative days in hospital. The recovery of patients still can reflect the advantages of vaginal surgery.