The Clinical Research Of Total Laparoscopic Hysterectomy (TLH) And Laparoscopic Assisted Vaginal Hysterectomy (LAVH)

Objective:To compare surgical outcomes of two procedures for large uterus:total laparoscopic hysterectomy(TLH)and laparoscopic assisted vaginal hysterectomy(LAVH).Methods:120 cases of large uterine patients(The weight of uterus after operation is more than280g)received in Zhenjiang maternal and child health care hospital from January2012 to December 2016 were selected as research subjects.The patients were divided into two groups:TLH group and group LAVH,60 cases each.The operation time,intraoperative blood loss,uterus weight,incidence of conversion to Peritoneotomy,postoperative exhaust time,postoperative Hb change value,postoperative pain index,postoperative leukocyte value,postoperative C-reactive protein value,Intraoperative bladder injury,operation complications,postoperative length of stay in hospital,surgical treatment cost,the proportion of new stress urinary incontinence,the cure rate of operation,postoperative recovery time of sexual life,sexual life satisfaction and so on were compared between the two groups.Results:The operation time of group LAVH was less than that of group TLH[(120.3±26.3)min vs.(141.2±35.1)min,t=3.694,P=0.000];and the postoperative pain index in TLH group was lesser than that in LAVH group[(3.1±1.0)vs.(4.0±1.8),t=-3.216,P=0.002].The incidence of conversion to Peritoneotomy was 5%in TLH group and0%in LAVH group,without statistical difference(P=0.244).There were no significantly difference between TLH group and LAVH group in the intraoperative blood loss[(106.3±88.8)ml vs.(132.7±112.7)ml,t=-1.422,P=0.158],and the postoperative exhaust time[(2.0±0.5)d vs.(1.9±0.4)d,t=1.474,P=0.143],and the changes of Hb[(9.3±6.4)g/L vs.(11.7±10.3)g/L,t=-1.552,P=0.123],and the postoperative leukocyte value[(7.95±2.22)10~?9/L vs.(7.49±2.12)10~?9/L,t=1.732,P=0.243],and the postoperative C-reactive protein value[(26.07±16.41)mg/L vs.(28.17±18.44)mg/L,t=-0.660,P=0.510].The complications incidence rate of postoperative pyrexia and other was 15.0%in TLH group and 12.9%in LAVH group,without statistical difference(?~2=0.069,P=0.793).There were no significantly difference between TLH group and LAVH group in the postoperative length of stay in hospital[(5.67±1.16)d vs.(6.05±1.06)d,t=-1.886,P=0.062],and the surgical treatment cost[(17187.3±3368.1)CNY vs.(16148.1±3042.0)CNY,t=1.774,P=0.079].The average follow-up time of the two groups was 6.5 and 6.6 months,and the long-term incidence of SUI was 14.5%and 8.9%,without statistical difference(?~2=0.279,P=0.597).The cure rate was 100%in both groups.The recovery time of sexual life was 123.3±36.5 and 121.3±33.8 days,without statistical difference(t=0.263,P=0.794);and no statistical difference in overall satisfaction index of sexual life(?~2=0.741,P=0.690).Conclusions:Total laparoscopic hysterectomy and laparoscopic assisted vaginal hysterectomy are both safe and effective treatment.The postoperative pain index of TLH operation is lesser,the time of LAVH operation is shorter.There was no significant difference between the results of the two surgical methods on the sexual life after operation,but both of them had significant influence on the sexual life after operation.