Tan Xian-jie, Lang Jing-he, Shen Keng, Liu Zhu-feng, Sun Da-wei, Leng Jin-hua, Zhu Lan
Department of Obstetrics and Gynecology, PUMC Hospital, CAMS and PUMC, Beijing 100730, China.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2003 Aug;25(4):406-9.
To examine the operative approaches, major indications, and medical economic parameters of the hysterectomy.
Data on hysterectomy performed due to benign gynecological disorders in Peking Union Medical College Hospital (PUMCH) from 1996 to 2001 were reviewed. The cases were classified into three groups according to the operative approaches: total abdominal hysterectomy (TAH), vaginal hysterectomy (VH), and laparoscopic assisted vaginal hysterectomy (LAVH). The major indications, length of hospital stay, operative cost, and total medical cost were analyzed.
Records of 4,180 women who had hysterectomies in PUMCH were examined. Operations included TAH (78.4%), LAVH (13.0%), and VH (8.6%). The use of LAVH increased from 2.4% in 1996 to 17.3% in 2001. The common indications for surgery included uterine leiomyoma (56.2%), adenomyosis (12.2%), benign ovarian tumor (9.2%), genital prolapse (7.7%), endometriosis (6.9%), atypical endometrial hyperplasia (3.0%), and cervical intraepithelial neoplasm (2.0%). The most common indications for TAH and LAVH were uterine leiomyomas and adenomyosis, whereas the most common indication for VH was genital prolapse, followed by uterine leiomyoma. The lengths of hospital stay in TAH, VH, and LAVH were (11.0 +/- 4.9) d, (10.9 +/- 3.9) d, and (8.9 +/- 3.7) d respectively. The total medical cost was (5,666.6 +/- 1,709.4) RMB Yuan for TAH, (5,027.6 +/- 1,067.0) RMB Yuan for VH, and (7,473.8 +/- 1,464.8) RMB Yuan for LAVH.
The use of LAVH has been increasing. Although the direct medical cost for LAVH is higher than that for TAH, its indirect benefit appeares superior to TAH. The major indications for LAVH and TAH are similar, whereas the indications for VH are different from those for TAH and LAVH.
探讨子宫切除术的手术方式、主要适应证及医疗经济学参数。
回顾北京协和医院1996年至2001年因良性妇科疾病行子宫切除术的数据。根据手术方式将病例分为三组：经腹全子宫切除术（TAH）、经阴道子宫切除术（VH）和腹腔镜辅助经阴道子宫切除术（LAVH）。分析主要适应证、住院时间、手术费用和总医疗费用。
检查了北京协和医院4180例行子宫切除术妇女的记录。手术包括TAH（78.4%）、LAVH（13.0%）和VH（8.6%）。LAVH的使用从1996年的2.4%增加到2001年的17.3%。常见的手术适应证包括子宫肌瘤（56.2%）、子宫腺肌病（12.2%）、良性卵巢肿瘤（9.2%）、生殖器脱垂（7.7%）、子宫内膜异位症（6.9%）、非典型子宫内膜增生（3.0%）和宫颈上皮内瘤变（2.0%）。TAH和LAVH最常见的适应证是子宫肌瘤和子宫腺肌病，而VH最常见的适应证是生殖器脱垂，其次是子宫肌瘤。TAH、VH和LAVH的住院时间分别为（11.0±4.9）天、（10.9±3.9）天和（8.9±3.7）天。TAH的总医疗费用为（5666.6±1709.4）元人民币，VH为（5027.6±1067.0）元人民币，LAVH为（7473.8±1464.8）元人民币。
LAVH的使用一直在增加。虽然LAVH的直接医疗费用高于TAH，但其间接益处似乎优于TAH。LAVH和TAH的主要适应证相似，而VH的适应证与TAH和LAVH不同。
