Seracchioli Renato, Venturoli Stefano, Vianello Federico, Govoni Francesca, Cantarelli Marianna, Gualerzi Beatrice, Colombo Filippo M
Center for Reconstructive Pelvic Endosurgery, Reproductive Medicine Unit, S. Orsola Hospital, University of Bologna, Massarenti 13, 40138 Bologna, Italy.
J Am Assoc Gynecol Laparosc. 2002 Aug;9(3):333-8. doi: 10.1016/s1074-3804(05)60413-6.
To evaluate in a prospective series whether, even in presence of a large uterus, total laparoscopic hysterectomy is feasible and safe, and may be substituted for abdominal hysterectomy.
Randomized comparison (Canadian Task Force classification I). Setting. Center for Reconstructive Pelvic Endosurgery, Bologna, Italy.
One hundred twenty-two women with large uterus (>14 wks' gestation) caused by myomas.
Total laparoscopic hysterectomy and total abdominal hysterectomy.
Sixty women underwent laparoscopic hysterectomy (group 1) and 62 abdominal hysterectomy (group 2). Mean longitudinal diameter of the uterus, mean number and diameter of myomas, operating time, and average drop in hemoglobin were similar in the groups. One conversion to laparotomy was necessary because of a bowel injury in a patient with severe pelvic adhesions. Cystotomy occurred in one woman in group 2 and was immediately repaired. Febrile morbidity was statistically more frequent in group 2 than in group 1. Postoperative hospitalization and convalescence were statistically shorter in group 1.
Laparoscopic hysterectomy is safe and feasible even in the presence of large uterus, and is a valid alternative to abdominal hysterectomy when the vaginal route is contraindicated.
在一个前瞻性队列研究中评估，即使存在子宫较大的情况，全腹腔镜子宫切除术是否可行且安全，以及是否可替代腹式子宫切除术。
随机对照研究（加拿大工作组分类I级）。地点：意大利博洛尼亚盆底重建内镜手术中心。
122例因肌瘤导致子宫较大（>14周妊娠）的女性。
全腹腔镜子宫切除术和全腹式子宫切除术。
60例患者接受腹腔镜子宫切除术（第1组），62例接受腹式子宫切除术（第2组）。两组患者子宫的平均纵径、肌瘤的平均数量和直径、手术时间以及血红蛋白平均下降幅度相似。1例严重盆腔粘连患者因肠损伤需中转开腹。第2组有1例患者发生膀胱切开术，已立即修复。第2组发热性并发症在统计学上比第1组更常见。第1组术后住院时间和康复时间在统计学上更短。
即使存在子宫较大的情况，腹腔镜子宫切除术也是安全可行的，并且在阴道途径禁忌时是腹式子宫切除术的有效替代方法。
