Taylor Susan M, Romero Audrey A, Kammerer-Doak Dorothy N, Qualls Clifford, Rogers Rebecca G
Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, 2211 Lomas Boulevard NE, Albuquerque, NM 87131, USA.
Am J Obstet Gynecol. 2003 Dec;189(6):1579-82; discussion 1582-3. doi: 10.1016/s0002-9378(03)00942-6.
The purpose of this study was to compare intraoperative and postoperative complications of abdominal hysterectomy for the enlarged, myomatous uterus with vaginal hysterectomy with morcellation.
Medical records of 139 patients who underwent vaginal hysterectomy with morcellation and 244 patients who underwent total abdominal hysterectomy for an enlarged, myomatous uterus between August 1990 and July 2001 were reviewed. Uterine weights of >982 g were excluded because this was the largest uterus removed vaginally, which left 208 evaluable cases of total abdominal hysterectomy. The perioperative and postoperative course of the two groups was compared. The Student t test was used for continuous variables, and the Fisher exact test was used for binary or categoric data.
There were no significant differences between the two groups in surgical or anesthetic risk factors (P>.05). Operative time was similar between the groups (P>.05). Length of hospital stay was increased significantly with total abdominal hysterectomy (mean, 3.9 days vs 2.6 days; P<.001). Perioperative complications were increased with the abdominal route (10% vs 25%, P<.001).
In this large series, uterine morcellation at the time of vaginal hysterectomy is safe and facilitates the removal of moderately enlarged and well-supported uteri and is associated with decreased hospital stay and perioperative morbidity rate compared with the abdominal route.
本研究旨在比较经腹子宫切除术治疗子宫增大伴肌瘤与经阴道子宫切除术加肌瘤粉碎术的术中及术后并发症。
回顾了1990年8月至2001年7月期间139例行经阴道子宫切除术加肌瘤粉碎术的患者及244例行经腹子宫切除术治疗子宫增大伴肌瘤患者的病历。子宫重量>982 g的病例被排除，因为这是经阴道切除的最大子宫，最终有208例可评估的经腹子宫切除术病例。比较两组的围手术期和术后病程。连续变量采用Student t检验，二元或分类数据采用Fisher精确检验。
两组在手术或麻醉风险因素方面无显著差异（P>0.05）。两组手术时间相似（P>0.05）。经腹子宫切除术的住院时间显著延长（平均3.9天对2.6天；P<0.001）。经腹手术途径围手术期并发症增加（10%对25%，P<0.001）。
在这个大样本系列中，经阴道子宫切除术时的肌瘤粉碎术是安全的，有助于切除中度增大且有良好支撑的子宫，与经腹手术途径相比，住院时间缩短，围手术期发病率降低。
