阴式与腹式切除非脱垂病变子宫312例比较分析.DOCVIP

临床医学论文-阴式与腹式切除非脱垂病变子宫312例比较分析 【摘要】? 目的? 探讨阴式切除非脱垂病变子宫手术在妇科领域的应用价值。方法? 回顾性分析比较阴式及腹式切除非脱垂病变子宫手术312例，记录患者的术前阳性体征、术中发现及术后恢复情况。结果? 阴式手术组手术时间及术中出血量明显少于腹式手术组（分别为70.64±17.65min和107.62±36.27min；88.6±34.3ml和105.6±25.0ml；P0.01），静脉用抗生素时间、肛门排气时间及住院时间均明显短于剖腹手术组（分别为3.66±2.23天和5.23±2.01天；1.34±0.51天和3.01±0.86天；5.32±3.96天和6.25±2.24天；P＜0.01）。结论? 阴式切除非脱垂病变子宫手术具有手术时间短、术中出血量少、术后胃肠功能恢复迅速、住院时间短等优点，值得推广应用。 　　【关键词】? 比较；腹式；阴式；子宫切除术；正常位置 ???? 【Abstract】? Objective? To investigate the clinical using of the transvaginal hysterectomy for a moderate enlarged normal-positioned uterus.Methods? To compare the vaginal hysterotomy and the abdominal hysterotomy of 312 cases.Their positive physical sign，detection in operation，length of stay and were recorded.The postoperative recovery was observed.Results? Operative time and bleeding in operation in the vaginal group were fewer than in abdominal group （70.64±17.65min vs 107.62±36.27min;88.6±34.3ml vs 105.6±25.0ml; P＜0.01）.The antibiotic time，functional recover time of bowel and length of stay in operative of the vaginal group were shorter than in the abdominal group （3.66±2.23 day vs 5.23±2.01 day，1.34±0.51 day vs 3.01±0.86 day，5.32±3.96 day vs 6.25±2.24 day，P＜0.01）.Conclusion? The vaginal hysterectomy was better than the abdominal hysterectomy in operativing time，bleeding in operation，functional recover of bowel and the length of stay.It was worth of popularizing，and using. ??? 【Key words】? compare;abdominal;through vagina;hysterectomy;normal position ??? 手术治疗非脱垂病变子宫，传统是采用经腹切除，但随着手术操作的大胆改进、更新，我院于2002～2005年已开展经阴道切除非脱垂病变子宫，且取得了良好的临床效果。现将选取同期经阴道及经腹切除非脱垂病变子宫的患者各156例的相关资料比较论述如下。 　　1? 资料与方法 ??? 1．1? 病例选择? 病例全部来自我院2002～2005年做全子宫切除的患者，其中经阴道及经腹切除子宫的病例各156例，年龄为36～68岁，平均46.3岁。有下腹部手术病史28例（8.97%），单纯子宫肌瘤112例（35.90%），子宫腺肌病29例（9.29%），子宫肌瘤并子宫腺肌病51例（16.35%），子宫肌瘤并卵巢良性肿瘤72例（23.08%），子宫肌瘤并早孕3例（0.96%），子宫内膜增殖症6例（1.92%），宫颈上皮内瘤样病变Ⅲ级11例（3.52%）。其中有关子宫体积大小的资料见表1。表1? 两组术前子宫增大情况比较 ??? 1．2? 手术选择? 凡符合下列要求的，有非脱垂病变子宫切除指征者在无手术禁忌证时，均可行经阴道子宫切除术［１］：（1）除外妇科恶性肿瘤；（2）子宫增大上限为16孕周；（3）有下腹手术史或估计存在盆