Clinical Application Of Trans-vaginal Hysterectomy

The first part:Vaginal hysterectomy and abdominal hysterectomyObjective:To investigate the advantage and disadvantage of vaginal hysterectomy compared with abdominal hysterectomy.Methods:Retrospectively, the clinical outcomes were compared between vaginal hysterectomy and abdominal hysterectomy on 86 patients, who were underwent hysterectomy. All the patients were admitted by The Second Hospital of Dalian Medical University and Dalian Gynecology and Obstetrics Hospital from 2005.3 to 2010.3. Among the 86 patients,69 cases were with myoma of uterus,9 cases were with adenomyosis,8 cases were with dysfunctional uterine bleeding.61 cases vaginal hysterectomy were compared with 25 cases abdominal hysterectomy, in respective of indication, operation time, operative bleeding, pain status after operation, bowel function recovery, the time of leaving bed, the average time of antibiotic administration, operation complication, and the average time stay at hospital after operation. The statistical analysis was conducted by the means of SPSS11.5 Package. Comparisons for continuous variables were based on the test or ANONA analysis and for categorical variables were based on the chi-square test.Results:Vaginal hysterectomy has the advantage of shorter operation time, recovery faster, less hemorrhage during operation, less painful after operation, less average time stay at hospital after operation, compared with abdominal hysterectomy. In general, TVH is superior to TAH.Conclusion:TVH is superior to TAH. But it is also compared with abdominal surgery, vaginal hysterectomy has its limit and disadvantage. The peritoneal cavity usually could not be explored extensively and the peritoneal lesions usually could not be treated because of the limited vision field. Skillful operation protocol is needed for this surgery and the injury of bladder and rectum should be avoided carefully, especially when meeting severe adhesion. Different procedures for total hysterectomy have their own advantages and disadvantages. And one procedure can not be replaced by another completely. In clinical practice, we should treat these two surgeries differently according to patient s characteristics and their willing, also we should know the applications of the two operations and enhance strong points and avoid weaknesses, in order to get the best outcome. The second part:Vaginal myomectomy and abdominal myomectomyObjective:To evaluate the feasibility, clinical effect and safety of vaginal myomectomy, compared with abdominal myomectomy.Method:Retrospectively, the clinical outcomes were compared between vaginal myomectomy and abdominal myomectomy on 70 patients who were underwent myomectomy. All the patients were admitted by The Second Hospital of Dalian Medical University and Dalian Gynecology and Obstetrics Hospital from 2005.3 to 2010.3. Among the 70 patients,46 cases were because of hyper menorrhea and frequency of urination,16 cases were because of found myoma of uterus on medical examination,6 cases were because of the myoma of uterus growthing rapidly,2 cases were because of myoma of uterus went with dysmenorrheal. We analyzed the clinical characteristics of 35 cases vaginal myomectomy and 35 abdominal myome-ctomy at the same period, compare the result of operation and of recovery.Results:Vaginal myomectomy has the shorter operation time, recovery faster, less hemorrhage during surgery, less painful. It indicates more advantage than abdominal myomectomy. But compared with abdominal myomectomy, vaginal myomectomy has its limit and disadvantage. The adnexa usually could not be explored and the vision field was limited. It needed Skillful operation protocol and had high rate of infection.Conclusion:The two methods have their advantages and disadvantages; they can t be instead of replaceable. In clinical practice, we should individualize these two surgeries according to patient s characteristics and willing, choice the cases carefully, in order to get the best outcome.