The Clinical Application Of Inproved Total Vaginal Hysterectomy For Non-prolapsed Uterus

Objective:Among the clinical application of the improved total transvaginal hysterectomy(TVH) in non-prolapsed uterus, the study was designed to probe into the preoperativecriteria for patient selection, summarize the key points of intraoperative procedure,evaluate incidence, characteristics and the prevention measures for the postoperativecomplications, and then provide reference for clinical practice.Patients and methods:Clinical data of the cases, who had the operative indications for hysteromyomaor adenomyosis and had been treated by the improved total vaginal hysterectomy fornon-prolapsed uterus in Fujian Province maternal and child care center during June2010to June2012, had been retrospectively analyzed. The clinical data, includingages, sizes of uterus, operation history of abdominopelvic cavity, consumption of theoperation time, blood loss, additional surgeries, postoperative exhaust time anddischarge time after operation, had been collected. The correlation between theoperation time and patient’s characteristics had been analysed by the mean of SAS9.0.Results:(1)283cases had been totally concerned. The patients ages varied from30years,the youngest, to59years, the oldest. The sizes of uterus varied from59cm3, theminimum, to1563cm3, the maximum. The average sizes of uterus were306cm3.There were47cases whose sizes of uterus were larger than12weeks pregnant,including2cases whose sizes of uterus were larger than16weeks pregnant. We hadfinished pelvic adhesion separation27cases, broad ligament myoma resection41 cases, adnexectomy and salpingectomy48cases, oophorocystectomy24cases (theovarian cysts≤6cm).The proportion of the blood loss during operation which wereless than50ml was91.17%(258/283). The consumption of the operation time were53minutes averagely. The postoperative exhaust time were28hours averagely. Thedischarge time after operation were5days averagely.(2) The correlation among the sizes of uterus, pelvic adhesion separation,treatment for the annex, resection for the broad ligament leiomyoma and theconsumption of the operation time were significant positive correlated. The patientsages, operation history of abdominopelvic cavity and pregnancy histories didn’t revealany significant correlation with the consumption of the operation time.(3) During the operation process, TVH had been converted into laparotomy in1case. Postoperative complications were found in6cases (occupied2.12%), includingpostoperative morbidity (3cases), venous thrombosis of the lower limbs (2cases) andbladder injury (1case). All of the cases have been cured and the cases who had beendischarged in the seventh days after TVH occupied93.64%of the total. All of thecases vaginal cuff were Healed well,had normal micturition and defecation, whichwere checked in2months postoperative follow-up examination.Discussion and conclusion:(1) For it is safe and minimally invasive, the operation mode is recommendablefor those, whose uterus were non-prolapsed and in good activity degree, and the sizeof uterus≤16gestational weeks, no matter with or without less than6cm ovarianbenign neoplasm.(2) In spite of the patients operation histories of abdominopelvic cavity andpregnancy and sexual experience, TVH is feasible to them.(3) Keeping the operating rule and prevention measures in mind, the surgicalcomplications would be reduced.(4) For the advantages of TVH, in terms of less of equipment, shorter operation time, less hemorrhage, less incidence of postoperative complications, shorter durationof hospital stay and no abdorminal scar, TVH is a low cost and high efficiencysurgical intervention, and is worth promoting.