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目的比较阴式全子宫切除术与腹式全子宫切除术的疗效及对患者性功能与心理健康状况的影响。方法 240例符合子宫切除术适应证的患者作为研究对象,根据采用的手术方法不同分为阴式组和腹式组,各120例。阴式组采用经阴道全子宫切除术,腹式组采用经腹全子宫切除术。比较两组患者手术时间、术中出血量、排气时间、下床活动时间、止痛药使用情况、抗生素使用时间、住院时间、住院费用及术后并发症发生情况,分别采用女性性功能指数(FSFI)、中国健康问卷(CHQ-12)评估术后患者性功能及心理状况。结果阴式组患者手术时间、术中出血量、排气时间、下床活动时间、止痛药使用情况、抗生素使用时间、住院时间及住院费用均显著优于腹式组,差异均具有统计学意义(P<0.01)。两组患者阴道息肉、阴道血肿、血栓静脉炎、输尿管损伤、膀胱损伤及直肠损伤发生率比较,差异均无统计学意义(P>0.05);阴式组切口延期愈合率0显著低于腹式组12.50%,差异具有统计学意义(P<0.01)。年龄<50岁时,阴式组患者各项FSFI评分均高于腹式组,但差异无统计学意义(P>0.05)。年龄≥50岁时,阴式组各项FSFI评分亦高于腹式组,且性欲望评分、性生活满意度评分及总分组间比较差异均具有统计学意义(P<0.05)。年龄<50岁时,阴式组患者CHQ-12得分及CHQ-12>4分比率均低于腹式组,但差异无统计学意义(P>0.05);年龄≥50岁时,阴式组CHQ-12得分及CHQ-12>4分比率亦低于腹式组,且CHQ-12得分组间比较差异具有统计学意义(P<0.05)。结论阴式全子宫切除术较腹式全子宫切除术创伤小、恢复快,对患者性功能及心理健康影响较小,值得临床推广。
Objective To compare the effects of vaginal hysterectomy and abdominal hysterectomy on sexual function and mental health of patients. Methods A total of 240 patients with hysterectomy indications were enrolled in this study. One hundred and twenty patients were divided into two groups according to different operative methods. Vaginal group with vaginal hysterectomy, abdominal group with abdominal hysterectomy. The operative time, intraoperative blood loss, excretion time, ambulation time, analgesic use, antibiotic use time, hospitalization time, hospitalization expenses and postoperative complications were compared between the two groups. Female sexual function index FSFI), Chinese Health Questionnaire (CHQ-12) to evaluate the postoperative patients with sexual function and psychological status. Results The operation time, intraoperative blood loss, exhaust time, ambulation time, analgesic use, antibiotic use time, hospitalization time and hospitalization cost of the vaginal group were significantly better than those of the abdominal group, the differences were statistically significant (P <0.01). There was no significant difference in the incidence of vaginal polyps, vaginal hematoma, thrombophlebitis, ureteral injury, bladder injury and rectal injury between the two groups (P> 0.05). The delayed healing rate of incision in negative group was significantly lower than that in abdominal Group 12.50%, the difference was statistically significant (P <0.01). At age <50 years, each FSFI score of patients in the vaginal group was higher than that of the abdominal group, but the difference was not statistically significant (P> 0.05). The FSFI score of the vaginal group was also higher than that of the abdominal group when the age was over 50 years old. And the score of Sexual Desire, Sexual Life Satisfaction and the difference between the total groups were all statistically significant (P <0.05). The CHQ-12 score and CHQ-12> 4 score in the negative group were lower than those in the abdominal group at age <50 years (P> 0.05), while those in the vaginal group CHQ-12 score and CHQ-12> 4 score were also lower than those of the abdominal group, and there was significant difference between CHQ-12 score group (P <0.05). Conclusions Vaginal hysterectomy is less invasive and faster than abdominal hysterectomy. It has less impact on sexual function and mental health of patients and is worthy of clinical promotion.