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目的:评价肥胖患者传统腹式子宫全切除术(TAH),经阴道子宫全切除术(TVH),腹腔镜辅助阴式子宫全切除术(LAVH)以及腹腔镜下全子宫切除术(TLH)4种手术的临床效果。方法:回顾分析238例采用以上4种术式行子宫切除术的手术时间、术中出血量、术后恢复情况。结果:四组子宫大小差异无统计学意义(P>0.05),TAH组手术时间明显长于TVH组、LAVH组及TLH组(均P<0.01);TVH组手术时间明显长于LAVH组(P<0.01),但与TLH相比差异无统计学意义(P>0.05);两组腹腔镜手术组手术时间相比LAVH组明显短于TLH组(P<0.01)。术中出血量TAH组多其他3组(均P<0.01);TVH组出血量多于LAVH组(P<0.01),与TLH组相比差异无统计学意义(P>0.05),两组腹腔镜组相比TLH组出血量多于LAVH组(P<0.05)。术后排气时间TAH组长于其他3组(均P<0.01);其他3组两两比较,差异无统计学意义(均P>0.05)。术后住院时间TAH组长于其他3组(均P<0.01);其他3组两两比较,差异无统计学意义(均P>0.05)。结论:4种术式均为肥胖患者全子宫切除的有效术式,应根据患者病情、医生的技术条件及现有设备来选择适宜的方法。
OBJECTIVE: To evaluate the efficacy of traditional abdominal hysterectomy (TAH), total vaginal hysterectomy (TVH), laparoscopic assisted vaginal hysterectomy (LAVH) and laparoscopic total hysterectomy (TLH) 4 The clinical effect of surgery. Methods: A retrospective analysis of 238 cases using the above four kinds of surgical hysterectomy operation time, blood loss, postoperative recovery. Results: There was no significant difference in uterine size between the four groups (P> 0.05). The operation time in TAH group was longer than that in TVH group, LAVH group and TLH group (all P <0.01) ), But there was no significant difference compared with TLH (P> 0.05). The operation time of laparoscopic surgery group was shorter than that of LAVH group (P <0.01). The amount of bleeding during operation in TAH group was significantly higher than that in LAVH group (all P <0.01), and the amount of bleeding in TVH group was more than that in LAVH group (P <0.01) Bleeding volume in TLH group was more than that in LAVH group (P <0.05). The exhaust time of TAH group was longer than that of the other three groups (all P <0.01). There was no significant difference between the other three groups (P> 0.05). The length of postoperative hospital stay was longer in TAH group than in other three groups (all P <0.01). There was no significant difference in the other three groups (P> 0.05). CONCLUSION: All the four surgical procedures are effective procedures for hysterectomy in obese patients. Appropriate methods should be selected according to the patient’s condition, the doctor’s technical conditions and the existing equipment.