Li Guang-yi, Shang Hui-ling, Chen Lu-shi
Department of Obstetrics and Gynecology, First People's Hospital of Foshan, Guangdong Province, China.
Zhonghua Fu Chan Ke Za Zhi. 2005 Mar;40(3):168-70.
To evaluate the clinical efficacy of four different operative patterns of laparoscopic hysterectomy: laparoscopically assisted vaginal hysterectomy (LAVH), laparoscopically introfasial subtotal hysterectomy (LISH), laparoscopically subtotal hysterectomy (LSH) and laparoscopically total hysterectomy (LTH).
A retrospective analysis on 2272 cases of laparoscopic hysterectomy was carried out, including operating time, blood loss, complication and postoperative recovery.
For the two groups which preserved cervix, LISH was performed in 1323 cases. The operating time was (91 +/- 21) min, blood loss (93 +/- 23) ml, complication rate 4.1%. LSH was conducted in 229 cases, with an operating time (70 +/- 18) min, blood loss (69 +/- 17) ml, complication rate 0. The difference between the two groups was significant (all P < 0.01). For the two groups which excised cervix, LAVH was performed in 588 cases, with an operating time (119 +/- 28) min, blood loss (156 +/- 23) ml, complication rate 1.5%; while LTH was carried out in 132 cases, with an operating time (121 +/- 30) min, blood loss (193 +/- 38) ml, complication rate 1.2%. There were no significant differences between the two groups (all P > 0.05). All patients recovered well postoperatively.
The four operative patterns are ideal for hysterectomy. Young patients should be operated with laparoscopic hysterectomy with preservation of cervix, old patients or patients with CIN should be operated with excision of cervix.
评估腹腔镜子宫切除术的四种不同手术方式：腹腔镜辅助阴式子宫切除术（LAVH）、腹腔镜筋膜内子宫次全切除术（LISH）、腹腔镜子宫次全切除术（LSH）和腹腔镜全子宫切除术（LTH）的临床疗效。
对2272例腹腔镜子宫切除术病例进行回顾性分析，内容包括手术时间、出血量、并发症及术后恢复情况。
在保留宫颈的两组中，1323例行LISH，手术时间为（91±21）分钟，出血量（93±23）毫升，并发症发生率4.1%；229例行LSH，手术时间（70±18）分钟，出血量（69±17）毫升，并发症发生率0。两组差异有统计学意义（均P<0.01）。在切除宫颈的两组中，588例行LAVH，手术时间（119±28）分钟，出血量（156±23）毫升，并发症发生率1.5%；132例行LTH，手术时间（121±30）分钟，出血量（193±38）毫升，并发症发生率1.2%。两组间无显著差异（均P>0.05）。所有患者术后恢复良好。
这四种手术方式均是子宫切除术的理想选择。年轻患者应行保留宫颈的腹腔镜子宫切除术，老年患者或患有宫颈上皮内瘤变（CIN）的患者应行切除宫颈的手术。
