腹腔鏡筋膜內子宮切除與陰式全子宮切除術對比分析

[摘要] 目的 對比分析腹腔鏡筋膜內子宮切除（LIH）與非脫垂陰式全子宮切除（TVH）的臨床效果，探討臨床適用性及改善手術效果的可行性。方法 隨機選擇該院2012年10月—2014年10月收治的有子宮切除指征的患者156例（A組），行LIH，同時期具備類似手術指征的非脫垂子宮130例（B組），行TVH，觀察術中出血量、手術時間，術后肩痛、腹脹發生率、肛門排氣時間、手術費用、住院天數及并發癥情況。結果 A組術中出血量（50.5±5.5）mL少于B組（200.6±30.5）mL，腹脹26.9%大于B組8.6%，肩痛32.7%大于B組，A組平均住院費用12 056.5元大于B組6 576.8元，均差異有統計學意義（P<0.05）；手術時間[A組（76.4±10.5）min，B組（85.2±5.1）min]、肛門排氣時間[A組（26.5±3.3）h，B組（25.8±5.4）h]、住院時間[（A組（7.2±1.2）d，B組（7.6±1.8）d]，均差異無統計學意義（P>0.05）；A組輸尿管損傷1例，皮下氣腫1例，子宮峽部殘端出血1例，B組膀胱損傷1例，1例右側附件膿腫。結論 二者均為微創手術，術后恢復快，TIH出血少，隨著陰式手術器械的改進，術中出血量將進一步減少，手術時間進一步縮短，二者各有優缺點，應針對手術適應癥，根據患者意愿及手術者技術熟練程度，選取手術方式，二者皆值得推廣。

[關鍵詞] 腹腔鏡；筋膜內子宮切除；陰式全子宮切除；對比分析

[中圖分類號] R713 [文獻標識碼] A [文章編號] 1674-0742（2016）12（b）-0079-03

Comparative Analysis of Laparoscopic Intrafascia Hysterectomy and Transvaginal Hysterectomy

GUO Qi-hang

Xiamen Haicang Hospital of Obstetrics and Gynecology，Xiamen，Fujian Province，361026 China

[Abstract] Objective To compare the clinical effect of laparoscopic fascia hysterectomy （LIH） and non prolapse transvaginal hysterectomy （TVH）， to explore the feasibility of clinical application and to improve the effect of surgery. Methods Randomly selected in our hospital in October 2012 to October 2014 from hysterectomy refers to 156 patients （group A）， LIH， at the same time have similar surgical indications of non prolapsed uterus in 130 cases （group B）， TVH，The amount of bleeding， operation time， the incidence of postoperative shoulder pain， abdominal distension， anal exhaust time， operation cost， hospital stay and complications were observed. Results The bleeding volume of A group（50.5±5.5）mL was less than that in group B（200.6±30.5）mL， 26.9% higher than that of group B abdominal distension 8.6%， shoulder pain 32.7% higher than that of B group， the average hospitalization expenses of 12 056.5 yuan more than 6 576.8 yuan in B group， were statistically significant （P < 0.05）； operation time [A group （76.4±10.5）min， B group （85.2±5.1）min]， anal exhaust time [A group （26.5 ±3.3）]h， B group [（25.8±5.4）h]， the hospitalization time [A group （7.2±1.2）days， B group（7.6±1.8）days]， had no statistical significance （P > 0.05）； A group 1 cases of ureter injury， 1 cases of subcutaneous emphysema， 1 cases of pelvic stump hemorrhage， 1 cases of B group bladder injury， 1 cases on the right side of accessory abscess. Conclusion The two are minimally invasive， rapid postoperative recovery， less bleeding TIH， with improved vaginal surgical instruments， intraoperative blood loss of TVH will be further reduced， the operation time is further shortened， the two have different advantages and disadvantages， should be according to the indications for surgery， according to the wishes of patients and the operation of skilled degree of selection the operation mode， the two are worthy of promotion.

[Key words] Laparoscopy； Internafascia hysterectomy； Transvaginal hysterectomy； Comparative analysis

子宮切除術是針對患有某些疾病的女性不得已采取的手術，無論采取何種手術方式，對患者到來說都是不小的損傷。近年來，隨著大家對微創手術的認識，腹腔鏡技術的引進，經陰道手術的開展及手術水平的進一步提高，子宮切除術給患者帶來的創傷在進一步減小，探討子宮切除的最優手術方式成為熱門研究[1]。……