改良式大子宫经阴道全切除术患者52例分析

　　【摘要】 目的 探讨改良式非脱垂大子宫经阴道全切除术(TVH)的安全性、可行性。方法 对52例非脱垂子宫大于孕12周并小于18周、活动、无严重粘连的子宫肌瘤、子宫腺肌瘤、子宫肌瘤合并子宫腺肌瘤患者，开展改良式非脱垂大子宫经阴道全子宫切除术。结果 52例患者非脱垂大子宫全部经阴道切除，手术成功率为100%，无一例盆腔脏器损伤，子宫平均重量为(540±60)g，手术平均时间为(79±13)min，估计平均失血量为(270±50)ml，肛门平均排气时间(25.53±2.3)h，术后出院平均时间为(5.5±1.5)天，术后镇痛率12%，术后病率7.7%。结论 经过适当的病例选择，改良式非脱垂大子宫经阴道全子宫切除术是一种安全有效的微创手术方式，值得临床推广应用。

　　【关键词】 大子宫;子宫全切除术;经阴道手术

　　Analysis on 52 patients with improved large uterus transvaginal resection

　　SUN Yan. Yanzhou People s Hospital,Yanzhou 272100,China

　　[Abstract] Objective To discuss the security and feasibility on improved non-prolapse large womb transvaginal hysterectomy(TVH).Methods Performed improved non-prolapse large womb TVH on 52 cases of non-prolapse womb with more than 12 weeks and less than 18 weeks pregnancy,active hysteromyoma without severe conglutination,adenomyoma of uterus,hysteromyoma and adenomyoma of uterus.Results 52 cases of non-prolapse vaginal total hysterectomies had 100% success rate.No patient was injured with cavum pelvis and viscera;average weight of womb is (540±60)g;average surgery time was(79±13)min;it was estimated that the average blood loss quantity was(270±50)ml;averange anus exhaustion time was (25.53±2.3)h;averange hospital leaving time after surgery was(5.5±1.5)d;anodyne rate after surgery was 12%，illness ratio after surgery was 7.7%.Conclusion Through proper case selection,the improved non-prolapse large womb vaginal total hysterectomy is a safe and effective minimally invasive surgery and it is worthwhile to be widely used in clinic.

　　[Key words] large womb;womb total resection; per vagina surgery

　　近年来，随着微创技术的不断发展，阴式子宫全切除术在临床逐渐开展，但传统的阴式子宫切除手术方法对非脱垂大子宫进行手术有很大难度。本院对52例非脱垂大子宫病变患者实施了改良式经阴道子宫切除术，取得满意效果，现报告如下。

　　1 资料与方法

　　1.1 一般资料 2007年11月—2009年8月山东省兖州市人民医院妇科收治因非脱垂子宫良性疾患拟行经阴道子宫全切除术患者52例，年龄35～52岁，平均44.23岁，均已婚。单纯子宫肌瘤31例，子宫肌瘤合并腺肌瘤13例，子宫腺肌症3例，子宫肌瘤合并卵巢囊肿5例(直径4～7cm)。子宫孕12～14周36例，孕14～16周14例，孕16～18周2例。既往有腹部手术史者9例，其中剖宫产3例，阑尾切

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