The Short-term Effect Of Laparoscopic Total Hysterectomy And Total Abdominal Hysterectomy On The Female Pelvic Floor

Objective: To evaluate the short-term postoperative effect on the pelvic floorand sex life of the patients who underwent laparoscopic total hysterectomyLTH(containing laparoscopic assisted vaginal hysterectomy LAVH) and totalabdominal hysterectomy TAH.Methods: From Nov.2009to Mar.2011,92patients were enrolled to devide intotwo group,one group containing46patients underwent laparoscopic totalhysterectomy LTH(including laparoscopic assisted vaginal hysterectomy LAVH), theother underwent total abdominal hysterectomy TAH, patients suffered from benignindications such as48cases fibroids uterine,28cases adenomyosis,12casesendometrial complex hyperplasia,12cases dysfunctional uterine bleeding andwithout pelevic floor dysfunction.Patients were assessed from stress urinaryincontinence，prolapse of vagina vault, bladder and rectum prolapse, quality of sexlife following up at6months and12months after hysterectomy.Result： No significant differences emerged in demographic and clinicalcharacte-ristics between the LTH group and the TAH group.In the LTH group, Theincidence of stress urinary incontinence is13.0%at6months after surgery and17.4%at12months after surgery; In TAH the group, The incidence of stress urinaryincontinence is8.7%at6months after surgery and17.9%at12months after surgery,no significant difference existed (P>0.05),but,in the LTH group, there is significantdifference between preoperative and postoperative(P＜0.05).In the TAH group,comparing12months after surgery to preoperative, significant difference existed (P＜0.05). Hysterectomy have little influence for prolapse of vagina vault, bladder andrectum prolapse.The influence for quality of sex life after hysterectomy, in the LTHgroup，comparing satisfaction of sexual life6months after surgery（78.3％） topreoperative（95.7％）, significant difference existed (P＜0.05),but comparingsatisfaction of sexual life12months after surgery（82.6％） to6months after surgeryand preoperative, no significant difference existed (P>0.05); In the TAH group, comparing satisfaction of sexual life12months after surgery to6months after surgeryand preoperative, significant difference existed (P＜0.05);At the same time,comparing satisfaction of sexual life, no significant differences emerged between theLTH group and the TAH group(P>0.05).Conclusions: The study shows that comparing to the traditional surgicalapproach TAH, LTH have more advantages,such as less bleeding, less time to returnto normal life and so on.But, whatever LTH or TAH,are harmful to pelvic floor,andincrease the morbidity of pelvic floor dysfunction. So we should take attention to thisproblem, and take more time to study it.