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目的 评价腹腔镜鞘膜内子宫切除术 (LISH)、腹腔镜子宫次全切除术 (LSH)、腹腔镜全子宫切除术(LTH)和腹腔镜辅助阴式子宫切除术 (LAVH)4种术式的临床效果。方法 回顾性分析各种腹腔镜子宫切除术 2272例的手术时间、出血量、并发症及术后恢复情况等。结果 保留子宫颈的两种术式中,LISH1323例(LISH组),手术时间为(91±21)min,出血量为 (93±23)ml,并发症发生率为 4 1%;LSH229例(LSH组),手术时间为(70±18)min,出血量为 (69±17)ml,无一例并发症发生;LISH组的手术时间、出血量及并发症发生率均高于LSH组,差异有统计学意义 (P<0.01)。去除子宫颈的两种术式中,LAVH588例(LAVH组),手术时间为(119±28)min,出血量为 (156±23)ml,并发症发生率为 1 0%;LTH132例(LTH组),手术时间为 (121±30)min,出血量为 (193±38)ml,并发症发生率 1 5%;LAVH组的手术时间、并发症发生率与LTH组比较,差异无统计学意义(P>0.05),而术中出血量LTH组明显多于LAVH组,差异有统计学意义(P<0.01)。结论 4种术式均为腹腔镜下子宫切除的有效术式,且各有利弊;应根据患者的具体情况选择适宜术式。
Objective To evaluate the efficacy and safety of laparoscopic sphincterotomy (LISH), laparoscopic subtotal hysterectomy (LSH), laparoscopic total hysterectomy (LTH) and laparoscopic assisted vaginal hysterectomy (LAVH) The clinical effect. Methods Retrospective analysis of a variety of laparoscopic hysterectomy 2272 cases of operation time, bleeding, complications and postoperative recovery and so on. Results There were two cases of LISH in 1323 cases (LISH group), the operation time was (91 ± 21) min, the bleeding volume was (93 ± 23) ml and the incidence of complications was 41% LSH group). The operative time was (70 ± 18) min and the amount of bleeding was (69 ± 17) ml. There was no complication in the LSH group. The operative time, bleeding volume and complication rate in LISH group were higher than those in LSH group There was statistical significance (P <0.01). Among the two surgical procedures for removing the cervix, LAVH588 cases (LAVH group) had a mean operation time of (119 ± 28) min and an amount of bleeding of (156 ± 23) ml and a complication rate of 10%. LTH132 cases (LTH Group). The operation time was (121 ± 30) min, the amount of bleeding was (193 ± 38) ml and the complication rate was 15%. There was no significant difference in operative time and complication between LAVH group and LTH group (P> 0.05), while the amount of intraoperative bleeding in LTH group was significantly more than LAVH group, the difference was statistically significant (P <0.01). Conclusions All four kinds of surgical procedures are effective surgical procedures for laparoscopic hysterectomy, and each has advantages and disadvantages. Patients should be given appropriate surgical procedures according to their specific conditions.