经阴道子宫切除术疗效观察.docVIP

经阴道子宫切除术疗效观察 　作者：谭月仙 茹英苗 莫劲思 【关键词】 经阴道子宫切除术 摘 要：目的:探讨经阴道子宫切除术的可行性及临床应用价值。方法:改良经阴道子宫切除手术步骤,对１８ 例有子宫切除手术适应症者行经阴道子宫切除术,取同期经腹切除子宫１８例作对比分析。结果:阴式组较腹式组手术时间长、术中出血稍多( P lt; 0. 0５),而术后肛门排气时间、术后镇痛例数、术后住院日阴式组少于腹式组( P lt; 0. 01)；术后病人满意度阴式组明显高于腹式组( P lt; 0. 01)；两者术后性生活满意度无差别。结论:阴式全子宫切除术具有术后疼痛轻,恢复快,住院日缩短，病人满意度高等优点,是一种安全、手术效果好、副反应少的手术方式。 　　关键词： 子 宫； 经阴道子宫切除术 　　Observing the Clinical Curative Effect of Vaginal Hysterectomy 　　Abstract: Objective： Observation of feasible and clinical application value of vaginal hysterectomy. Method: Improving vaginal hysterectomy procedure for 18 cases of patients who are applicable to hysterectomy involved with vaginal hysterectomy. Taking 18 cases of patients for belly and vaginal hysterectomy as comparison analysis. Result: The virginal type group is longer time than belly type and bleeding is more slightly in operation (Plt;0.05); but the exhausting gas from the cavity of bottom, pain killing cases and inward days for virginal type after operation are less than belly type group (Plt;0.01); The satisfactory degree of virginal type is apparently than belly type group (Plt;0.01); Two groups have no difference for sex after operation. Conclusion: The virginal type of entire womb cutting operation has advantage of slight pain, fast recovery, short inward period after operation so that the patients are satisfactory. Therefore, it is a safe, good effect and less side-effect operation. 　　Key words: Uterine; Vaginal hysterectomy 　　我们采用经过改良的阴式全子宫切除术，简化了手术步骤,取得良好效果,现将其方法和临床疗效总结如下。 　　1 资料与方法 　　1.1 临床资料：将36例因子宫良性病变行全子宫切除的患者分为两组: 阴式全宫切除18例,年龄35～56岁,平均43岁; 其中子宫肌瘤12例, 子宫腺肌瘤4例, 功能失调性子宫出血2例。常规腹式全子宫切除18例, 为对照组, 年龄32～ 52岁, 平均45岁; 其中子宫肌瘤10例,子宫腺肌瘤5例, 功能失调性子宫出血3 例。两组患者均有一胎以上生育史, 两组子宫均lt;1２周, 活动度好, 除术前常规妇检外, 所有患者均作宫颈细胞学涂片检查, 对于不规则阴道流血者,分段诊刮排除子宫恶性病变。 　　1.2 手术方法 　　1.2.1 阴式全子宫切除手术操作:病人取截石位,常规消毒、铺巾、导尿、暴露宫颈。在膀胱沟下与后穹窿与宫颈交界处中间粘膜下注射立止血1u加生理盐水混合液２０ｍｌ。于膀胱宫颈沟下方约3mm处环绕宫颈切开宫颈与阴道交界粘膜,深3～4mm达宫颈粘膜，电刀钝锐性分离膀胱宫颈间隙及宫颈直肠间隙,达前后腹膜反折，打开前后腹膜靠宫颈一次性钳夹骶主韧带，切断后缝扎近端的断端,宫颈侧不缝。此时再次触摸子宫,了解子宫大小,活动度,肌瘤