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目的探讨非脱垂子宫阴式子宫全切除术(TVH)的适应证和禁忌证。方法回顾性分析我院1992年6月至2003年6月间2086例非脱垂子宫TVH的临床资料,按子宫体积、既往有无盆腹腔手术史、有无阴道分娩史、是否同时处理附件等分别进行统计,比较手术并发症的发生情况。结果(1)不同体积子宫比较:子宫体积>16孕周患者的非脱垂子宫TVH手术时间、术中出血量及术后盆腔感染率分别为(73±25)min、(237±86)ml、1.69%(7/413);子宫体积≤16孕周患者的非脱垂子宫TVH手术时间、术中出血量及术后盆腔感染率分别为(42±16)min、(101±58)ml、0.78%(13/1673),不同体积子宫上述各项指标比较,差异有统计学意义(P<0.01)。(2)既往有无盆腹腔手术史比较:既往有无盆腹腔手术史患者的非脱垂子宫TVH手术时间和术中出血量比较,差异无统计学意义(P>0.05),但有盆腹腔手术史患者非脱垂子宫TVH的术中并发症发生率升高;(3)有无阴道分娩史患者非脱垂子宫TVH的手术时间和术中出血量比较,差异也无统计学意义(P>0.05);119例合并卵巢囊肿患者均成功行非脱垂子宫TVH。结论子宫体积≤16孕周患者的非脱垂子宫TVH是安全、可行的,子宫体积>16孕周患者的非脱垂子宫TVH手术难度较大,是否行TVH,需根据术者的经验及患者的情况进行选择;既往有盆腹腔手术史,可增加非脱垂子宫TVH并发症的发生率;对于子宫体积≤16孕周的患者,有无阴道分娩史均不影响TVH的成功率;TVH同时处理直径≤6cm的卵巢单纯性囊肿是可行的。
Objective To investigate the indications and contraindications of vaginal hysterectomy (TVH) in non-prolapsed uterus. Methods A retrospective analysis of our hospital from June 1992 to June 2003 2086 cases of non-prolapsed uterine TVH clinical data, according to the volume of the uterus, with or without history of abdominal surgery, with or without vaginal delivery history, whether the simultaneous treatment of attachments, etc. Statistics were made to compare the occurrence of surgical complications. Results (1) Comparison of different volume of uterus: TVH operation time, intraoperative blood loss and postoperative pelvic infection rate of non-prolapsed uterus in patients with uterine volume> 16 weeks were (73 ± 25) min, (237 ± 86) ml , And 1.69% (7/413) respectively. The time of TVH operation, intraoperative blood loss and postoperative pelvic infection were (42 ± 16) min and (101 ± 58) ml in non-prolapsed uterus , 0.78% (13/1673). There was significant difference between the above indexes in different volume of uterus (P <0.01). (2) Comparison of past history of pelvic and abdominal surgery: there was no significant difference in TVH operation time and intraoperative blood loss in patients with history of abdominal pelvic surgery (P> 0.05) The incidence of intraoperative complications of non-prolapsed uterine TVH in patients with surgical history increased; (3) There was no significant difference in operative time and intraoperative blood loss between non-prolapsed uterine TVH patients with or without vaginal delivery (P > 0.05); 119 cases of patients with ovarian cyst were successfully treated with non-prolapsed uterine TVH. Conclusion Non-prolapsed uterine TVH is safe and feasible in patients with uterine volume≤16 gestational weeks. It is more difficult to treat non-prolapsed uterine TVH in patients with uterine volume> 16 weeks. Whether to perform TVH depends on the experience of the surgeon and the patients The history of pelvic surgery can increase the incidence of non-prolapsed uterine TVH complications; for uterine volume ≤ 16 gestational weeks in patients with or without vaginal delivery history TVH success rate did not affect; TVH at the same time Treatment of ovarian simple cysts ≤ 6cm in diameter is feasible.