Clinical Study On Transvaginal Intrafascial Hysterectomy With Intact Ascending Uterine Artery

Objective To investigate the clinical value of transvaginal intrafascial hysterectomy with intact ascending uterine artery.Method A retrospective analysis of 21 cases of uterine fibroids to be passing through the vaginal intrafascial hysterectomy with intact ascending uterine artery in the January 2006～Mar 2007.From the course of surgery and postoperative recovery to analysis procedure of ovarian function,urine and sexual situations. Observed,including operation time,blood loss,postoperative recovery of patients with postoperative morbidity,the occurrence of urinary retention of removing catheter at 24 hours after operration,after the time out of bed and exhaust time.The variables of operation and postoperation were studied and compared,especially the ovarian function and sexuality.Ovarian function has observed follicle stimulating erythropoietin(FSH),luteinizing hormone(LH),estradiol(E2) and menopausal symptoms(hot flashes,sweating,weakness),and urine to investigate the impact of the situation,including urine Frequency,urinary incontinence,bowel habits change, and so on,all these indicators in 1,6,12 months after the operation carried out follow-up.Sexual content,including the investigation of the frequency of life, satisfaction,follow-up to the time before and after operation for 6 months,after 12 months.This study was compared with historical clinical value of intrafascial hysterectomy with intact ascending uterine artery and conducted statistical analysis on the indicators. Rseults 21 cases of patients with vaginal surgery have been successfully completed.In the study group the mean operative time was 70±21min,the average blood loss 81±17 ml.The postoperation exhausting time was 19±2.1 hrs.The interval of operation to normal movement was 15±6 hrs.Within 24 h after removal of catheter,no case of urinary retention,postoperative morbidity was 4.8 percent(1/ 21).The level of FSH(u/l) measured preoperation and 1,6,12month postoperation correspondingly were:4.75±1.26,5.53±1.02,5.64±2.72,5.69±2.34:The level of LH(u/l) measured preoperation and 1,6,12month postoperation correspondingly were: 12.55±2.30,13.33±3.11,13.85±2.21,13.83±1.58;The level of E₂(pmol/L)measured preoperation and 1,6,12month postoperation correspondingly were:345.15±13.13,335.85±15.22,334.24±25.34,331.22±9.53.The results showed that:study group's operating time was a little longer in the historical control group,blood loss more than the historical control group,but the difference was not significant(P＞0.05).The exhaust time,time to get out of bed in the study group was significantly shorter than the historical control group,significant differences(P＜0.05).Postoperative fever, bleeding of of the two groups showed no significant difference.The level of FSH(u/l) in the study group measured 1 month postoperation had increased,but compared with the preoperative no significant difference(P＞0.05).The level of E2(u/l) in the study group measured 12 month postoperation had decreased,but compared with the preoperative no significant difference(P＞0.05).Although these two indicators in the historical control group minor changes,but compared with the preoperative no significant difference.LH levels of the two groups were not significantly higher,no significant difference(P＞0.05).The increasing percents in sexual desire of study group and historical control group after postoperative were 33.3%and 20.5%, compared to the two groups,no significant difference(P＞0.05).Sex life satisfaction increasing percents were 66.7%and 41.0%,compared to the two groups,significantly different(P＜0.05).In the study group 1 case with urinary tract symptoms appeared, only 1 case with constipations,the historical control group were 2 and 1,no significant difference between the two groups compared(P＞0.05).Conclusions Transvaginal intrafascial hysterectomy with intact ascending uterine artery could be performed with facility,less complications and slight influences on intestine,and other advantages.After six months of follow-up,ovarian function in the near future impact was no change.But 1 year after operation the level of decreased ovarian function decreased a little.Study group on the sex life had little effect,Compared with the historical control group,the sex life satisfaction improved significantly.Few patients had symptoms of urinary and defecate.This operation could improve the quality of life of the patients,the long-term clinical effects should be further followed and studied.