Ottosen C, Lingman G, Ottosen L
Department of Obstetrics and Gynaecology, Hospital of Helsingborg, Sweden.
BJOG. 2000 Nov;107(11):1380-5. doi: 10.1111/j.1471-0528.2000.tb11652.x.
To detect differences in clinical short term outcome between total abdominal hysterectomy, vaginal hysterectomy and laparoscopic assisted vaginal hysterectomy.
Randomised controlled trial.
Department of Obstetrics and Gynaecology, Hospital of Helsingborg, Sweden.
One hundred-twenty women scheduled for hysterectomy for various indications.
Randomisation into three treatment arms: total abdominal hysterectomy (n = 40); vaginal hysterectomy (n = 40) and laparoscopic assisted vaginal hysterectomy (n = 40). During traditional abdominal and vaginal surgery, laparoscopic assistance was kept to a minimum. Substantial number of cases needed volume-reducing manoeuvres due to uterine size.
Duration of surgery, anaesthesia, time in hospital and recovery time.
Mean duration (range) of surgery was significantly longer for laparoscopic assisted vaginal hysterectomy compared with vaginal hysterectomy and total abdominal hysterectomy, 102 min (50-175), 81 min (35-135) and 68 min (28-125), respectively. Mean stay in hospital and mean time to recovery was significantly longer for total abdominal hysterectomy compared with vaginal hysterectomy and laparoscopic assisted vaginal hysterectomy. The difference between vaginal hysterectomy and laparoscopic assisted vaginal hysterectomy was not significant. It was possible to remove uteri under 600 g with all three methods. Four laparoscopic assisted vaginal hysterectomies and one vaginal hysterectomy were converted to open surgery. Reoperation and blood transfusion were required after two vaginal hysterectomies and one laparoscopic assisted vaginal hysterectomy. One woman needed blood transfusion after total abdominal hysterectomy.
Traditional vaginal hysterectomy proved to be feasible and the faster operative technique compared with vaginal hysterectomy with laparoscopic assistance. The abdominal technique was somewhat faster, but time spent in theatre was not significantly shorter. Abdominal hysterectomy required on average a longer hospital stay of one day and one additional week of convalescence compared with traditional vaginal hysterectomy. Vaginal hysterectomy should be a primary method for uterine removal.
检测全腹子宫切除术、经阴道子宫切除术和腹腔镜辅助经阴道子宫切除术在临床短期结局上的差异。
随机对照试验。
瑞典赫尔辛堡医院妇产科。
120名因各种适应症计划接受子宫切除术的女性。
随机分为三个治疗组：全腹子宫切除术（n = 40）；经阴道子宫切除术（n = 40）和腹腔镜辅助经阴道子宫切除术（n = 40）。在传统的腹部和阴道手术中，腹腔镜辅助降至最低限度。由于子宫大小，大量病例需要进行减容操作。
手术持续时间、麻醉时间、住院时间和恢复时间。
与经阴道子宫切除术和全腹子宫切除术相比，腹腔镜辅助经阴道子宫切除术的平均手术持续时间（范围）明显更长，分别为102分钟（50 - 175分钟）、81分钟（35 - 135分钟）和68分钟（28 - 125分钟）。与经阴道子宫切除术和腹腔镜辅助经阴道子宫切除术相比，全腹子宫切除术的平均住院时间和平均恢复时间明显更长。经阴道子宫切除术和腹腔镜辅助经阴道子宫切除术之间的差异不显著。三种方法均有可能切除600克以下的子宫。4例腹腔镜辅助经阴道子宫切除术和1例经阴道子宫切除术转为开放手术。2例经阴道子宫切除术和1例腹腔镜辅助经阴道子宫切除术后需要再次手术和输血。1例全腹子宫切除术后需要输血。
传统经阴道子宫切除术被证明是可行的，并且与腹腔镜辅助经阴道子宫切除术相比是更快的手术技术。腹部手术技术稍快，但在手术室花费的时间没有明显缩短。与传统经阴道子宫切除术相比，全腹子宫切除术平均需要多住院一天和多一周的康复时间。经阴道子宫切除术应作为子宫切除的主要方法。
