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目的:对比研究腹腔镜辅助下阴式子宫全切术(laparoscopic-assisted vaginal hysterectomy,LAVH)与阴式子宫全切术(transvaginal hysterectomy,TVH)在非脱垂子宫切除中的临床效果。方法:回顾分析119例采用以上2种方式子宫切除的临床资料,其中LAVH 65例,腹腔镜下断离子宫圆韧带、附件及阔韧带系膜至子宫动静脉,打开膀胱反折腹膜下推膀胱后,转为阴式手术切除子宫;TVH 54例,经阴道切开宫颈筋膜,打开前、后反折腹膜,断离骶、主韧带及子宫血管,断离宫旁组织及双侧附件,取出子宫。结果:TVH 5例转腹腔镜辅助下手术。LAVH手术时间(145±38)min,TVH(85±35)min;LAVH术中出血量(150±35)ml,TVH(85±30)ml;LAVH手术并发症发生率3.0%(2/65),阴式组3.7%(2/54)。术后住院时间LAVH(6.1±1.4)天,TVH(6.3±1.8)天;LAVH住院总费用(6 925±870)元,TVH(3 585±380)元。结论:两者各有其优势。腹腔镜辅助下阴式子宫全切术显著扩大了阴式子宫全切术的适应证,手术更安全。阴式子宫全切术具有手术时间短、失血少、费用低廉的优点,值得在基层医院推广应用。
Objective: To compare the clinical effects of laparoscopic-assisted vaginal hysterectomy (LAVH) and transvaginal hysterectomy (TVH) in non-prolapsed hysterectomy. Methods: A retrospective analysis of 119 cases of hysterectomy using the above two kinds of clinical data, including 65 cases of LAVH, laparoscopic broken uterine ligament, attachment and broad ligament mesangial to the uterine artery and vein, open the bladder buckling peritoneal bladder After transurethral resection of the uterus; TVH 54 cases, vaginal incision cervix fascia, open the front and back antiperiodic peritoneum, off the sacral, the main ligament and uterine blood vessels, off the uterine tissue and bilateral attachment, remove uterus. Results: Five cases of TVH were assisted by laparoscopy. The operative time of LAVH was (145 ± 38) min, TVH was (85 ± 35) min, the amount of bleeding in LAVH was (150 ± 35) ml and TVH was (85 ± 30) ), 3.7% (2/54) in the vaginal group. The length of postoperative hospital stay was 6.1 ± 1.4 days, TVH was 6.3 ± 1.8 days, total length of LAVH hospital admission was 6 925 ± 870 yuan, and TVH was 3 585 ± 380 yuan. Conclusion: Both have their own advantages. Laparoscopic assisted vaginal hysterectomy significantly expanded the indication of vaginal hysterectomy surgery more secure. Vaginal hysterectomy with short operative time, less blood loss, the advantages of low cost, it is worth to promote the use of primary hospitals.