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目的探讨筋膜内全子术宫切除术的临床应用价值。方法回顾性分析筋膜内全子宫切除术患者105例(筋膜内组)临床资料,并与同期筋膜外子宫切除术患者90例(筋膜外组)的资料比较。结果与筋膜外组相比,筋膜内组具有手术时间短[(75±10.5)min vs.(110±38.6)min](P<0.05)、术中出血量少[(80±56)ml vs.(192±93)ml](P<0.05)和术后并发症少的优势。术后3个月复查结果显示,筋膜内组患者阴道出血[(2.9%)vs.(10.0%)]、残端息肉[(6.7%)vs.(17.8%)]和排便不适[(5.7%)vs.(8.9%)]发生率均明显低于筋膜外组(P<0.05),筋膜内组患者性生活满意率明显高于筋膜外组[(92.3%)vs.(79.6%)](P<0.05)。结论筋膜内全子宫切除术保存了子宫主、骶韧带及宫旁组织,从而维护了盆底的支撑结构;且在筋膜内操作不易损伤膀胱、输尿管及直肠,缩短手术时间,降低手术风险。
Objective To investigate the clinical value of intrafascial total hysterectomy. Methods The clinical data of 105 patients with intrafascial total hysterectomy (fascia group) were retrospectively analyzed. The data were compared with those of 90 cases of extrafascial hysterectomy (extra-fascicular group). Results Compared with the extrafascial group, the intrafascial group had shorter operative time [(75 ± 10.5) min vs. (110 ± 38.6) min] (P <0.05) and less intraoperative bleeding (80 ± 56) ml vs. (192 ± 93) ml] (P <0.05) and less postoperative complications. Postoperative 3 months of follow-up showed that intrafascial vaginal bleeding (2.9% vs. 10.0%), stump polyps (6.7%) vs. (17.8%), and defecation discomfort (5.7 %) vs (8.9%)] were significantly lower than those outside the fascia (P <0.05). The satisfaction rate of sexual life within the fascia was significantly higher than that of the extrafascial group [(92.3%) vs. (79.6 %)] (P <0.05). Conclusion Fascia hysterectomy preserves the main uterus, the sacral ligaments and the paravertebral tissues, thus maintaining the pelvic floor support structure. In the fascia, it is not easy to damage the bladder, ureter and rectum, shortening the operation time and reducing the operation risk .