25例子宫脱垂伴阴道前后壁膨出行阴式子宫切除术后疗效观察(1)
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[摘要] 目的 探讨阴式子宫切除术治疗子宫脱垂伴阴道前后壁膨出的疗效。 方法 回顾性分析本院妇产科2009年1月～2010年1月25例行阴式子宫切除术治疗子宫脱垂伴阴道前后壁膨出患者的手术方法(腹腔镜辅助和单纯阴式子宫切除术)和疗效。 结果 观察组手术时间[(50±16) min]、术中出血量[(160±28) mL]、并发症发生率(6.98%)、住院时间[(4.3±0.5) d]和排气时间[(18.1±8.0) h]均少于对照组，差异有统计学意义。 结论 腹腔镜下阴式子宫切除术具有手术视野暴露清晰，能彻底止血，治疗所需时间短、并发症少的优点，是较为理想的手术方式，值得临床推广应用。
[关键词] 子宫脱垂；伴阴道前后壁膨出；阴式子宫切除术；疗效观察
[中图分类号] R713.4+2 [文献标识码] A [文章编号] 1674-4721(2012)02(b)-0040-02
Curative effect observation of 25 cases of vaginal hysterectomy patients with uterine prolapse with anterior and posterior vaginal anterior and posterior vaginal encephalocele
YANG Jinxiang
The People's Hospital of Jingzhou County in Huaihua City of Hu'nan Province, Jingzhou 418400, China
[Abstract] Objective To investigate the treatment effect of uterine prolapse with anterior and posterior vaginal encephalocele treated with vaginal hysterectomy. Methods The surgical approach (laparoscopic assisted vaginal hysterectomy and surgery alone) and efficacy of the 25 cases of vaginal hysterectomy patients with uterine prolapse with anterior and posterior vaginal anterior and posterior vaginal encephalocele from January 2009 to January 2010 in gynecology and obstetrics of our hospital were analysed retrospectively, the operation method and the treatment effect were analyzed. Results The operative time[(50±16) min], blood loss[(160±28) mL], rate of complications (6.98%), hospital stay[(4.3±0.5) d] and discharge time[(18.1±8.0) h] in the observation group were all less than that of the control group, there were significant difference between two groups. Conclusion Laparoscopic vaginal hysterectomy with a clear operative field exposure is an ideal surgical method which can completely stop the bleeding, the treatment time is short, the advantages of complications are fewer. It is worthy of clinical application.
[Key words] Uterine prolapse; Anterior and posterior vaginal encephalocele; Vaginal hysterectomy; Curative effect observation
子宫脱垂是指支撑子宫的组织受损伤或薄弱，子宫从正常位置沿阴道下降，子宫颈外口达坐骨棘水平以下，甚至子宫全部脱出阴道口外的一种生殖伴邻近器官变位的综合征[1]。子宫脱垂常伴阴道前后壁膨出，可采用保守治疗或手术方法治疗。治疗方案应个体化。因子宫脱垂多为老年患者，治疗以安全、简单和有效为原则。阴式子宫切除术是目前临床应用较为广泛的治疗方法[2]。为探讨子宫脱垂伴阴道前后壁膨出行腹腔镜下阴式子宫切除术的疗效，笔者对本院25例患者的病历资料进行了回顾性分析和比较，现报道如下：
1 资料与方法
1.1 一般资料
选取本院妇产科2009年1月～2010年1月收治的子宫脱垂患者25例，年龄38～76岁，平均(57±16.5)岁。所有患者均婚育，其中孕次为2～8次，产次为2～8次，重体力劳动者13例，山区患者7例，其他5例。随机分为对照组(阴式子宫切除12例)和观察组(腹腔镜辅助阴式子宫切除13例)。
观察组子宫脱垂Ⅰ度2例，Ⅱ度6例，Ⅲ度5例，伴阴道前壁后壁膨出Ⅰ度2例，Ⅱ度7例，Ⅲ度4例；
对照组Ⅰ度2例，Ⅱ度5例，Ⅲ度5例，伴阴道前壁后壁膨出Ⅰ度2例，Ⅱ度6例，Ⅲ度4例。
Ⅱ、Ⅲ度患者常有不同程度腰骶部酸痛、下腹部坠胀，行动不便、尿失禁、排尿困难 ......
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