Lumsden M A, Twaddle S, Hawthorn R, Traynor I, Gilmore D, Davis J, Deeny M, Cameron I T, Walker J J
Western Infirmary, Southern General Hospital, Glasgow.
BJOG. 2000 Nov;107(11):1386-91. doi: 10.1111/j.1471-0528.2000.tb11653.x.
To determine the safety, cost effectiveness and effect on quality of life of laparoscopic-assisted vaginal hysterectomy (LAVH) compared with total abdominal hysterectomy (TAH) in the management of benign gynaecological disease.
Randomised controlled trial and economic evaluation.
Three hospitals in the West of Scotland.
Two hundred women scheduled for an abdominal hysterectomy for benign gynaecological disease.
Conversion rate of LAVH to TAH, complication rates, NHS resource use and costs, quality of life using EuroQol 5 D visual analogue scale, and achievement of milestones.
The overall incidence of operative complications was 14% in the TAH group and 8% in the LAVH group, with an 8% conversion rate. Length of operation was significantly greater in the women having LAVH at 81 +/- 30 min vs 47 +/- 16 min (P < 0.001). There was no difference in analgesic requirements between the groups although there was a significantly shorter hospital stay for those having LAVH. The rate of post-surgery recovery, satisfaction with operation and quality of life at four weeks post-operative were similar in the two groups of women. LAVH was significantly more expensive than TAH and remained more expensive for all but the most extreme scenario.
This study demonstrates that despite the decreased length of hospital stay, LAVH is more expensive than TAH. In addition, recovery following operation and patient satisfaction were not affected by the route chosen. It is unlikely that LAVH represents an efficient use of NHS resources.
确定在治疗良性妇科疾病时，与经腹全子宫切除术（TAH）相比，腹腔镜辅助阴式子宫切除术（LAVH）的安全性、成本效益及对生活质量的影响。
随机对照试验及经济学评估。
苏格兰西部的三家医院。
200名计划因良性妇科疾病接受腹部子宫切除术的女性。
LAVH转为TAH的转化率、并发症发生率、英国国家医疗服务体系（NHS）资源使用及成本、使用欧洲五维健康量表（EuroQol 5 D）视觉模拟量表评估的生活质量，以及各关键指标的达成情况。
TAH组手术并发症的总体发生率为14%，LAVH组为8%，转化率为8%。LAVH组女性的手术时间明显更长，为81±30分钟，而TAH组为47±16分钟（P<0.001）。两组之间的镇痛需求无差异，不过LAVH组的住院时间明显更短。两组女性术后四周的恢复速度、对手术的满意度及生活质量相似。LAVH比TAH成本显著更高，除了最极端的情况外，在所有情况下都更昂贵。
本研究表明，尽管LAVH组住院时间缩短，但比TAH成本更高。此外，手术恢复情况及患者满意度不受手术方式选择的影响。LAVH不太可能是NHS资源的有效利用方式。
