Lyons Thomas L, Adolph Allyson J, Winer Wendy K
Center for Women's Care and Reproductive Surgery, Atlanta, Georgia, USA.
J Am Assoc Gynecol Laparosc. 2004 May;11(2):170-4. doi: 10.1016/s1074-3804(05)60193-4.
The purpose of this study was to review outcomes of laparoscopic supracervical hysterectomy (LSH) performed on patients with large uteri and compare those outcomes with existing series of hysterectomies reporting removal of large uteri.
Retrospective analysis (Canadian Task Force classification II-3).
Single surgeon, independent surgery center.
Women with symptomatic myomas and/or menorrhagia.
Laparoscopic supracervical hysterectomy.
All patients undergoing LSH procedures for uteri weighing more than 300 g between the years 1997 and 2001 were evaluated. A retrospective chart review and videotape review were used to assess outcome measures including operative time, complications, estimated blood loss, uterine weight, and pathologic diagnoses. A quality of life questionnaire was submitted to the patients postoperatively. During the 5 years of the study, 329 LSHs were performed, 54 (16.4%) involved uterine weight greater than 300 g, and 31 (67%) of this group had a uterine weight greater than 500 g. Seven patients (2%) had complex pathologies with leiomyomata and endometriosis. There were five cases of reported complications: two intraoperative complications and three postoperative fevers. One procedure was converted to laparotomy. Transfusion rate was 0%, with an average estimated blood loss of 77 mL. The mean number of days to return to work or normal activity was 10.1. Sexual relations were reported to be as good as or better than before the procedure in 88.9% of patients. All the patients reported being satisfied with the procedure.
The LSH procedure in this series provided an effective, low-morbidity alternative for patients with large uteri to accomplish uterine extirpation. Since reduction of morbidity and improved quality of care for women undergoing hysterectomy are goals of all gynecologists, we believe that LSH is an alternative that should be considered.
本研究旨在回顾对子宫较大的患者实施腹腔镜次全子宫切除术（LSH）的结果，并将这些结果与已报道的切除较大子宫的子宫切除术系列进行比较。
回顾性分析（加拿大工作组分类II-3）。
单一外科医生，独立手术中心。
有症状性肌瘤和/或月经过多的女性。
腹腔镜次全子宫切除术。
对1997年至2001年间所有因子宫重量超过300克而接受LSH手术的患者进行评估。通过回顾病历和观看录像带评估手术时间、并发症、估计失血量、子宫重量和病理诊断等结果指标。术后向患者发放生活质量问卷。在研究的5年期间，共进行了329例LSH手术，其中54例（16.4%）子宫重量超过300克，该组中有31例（67%）子宫重量超过500克。7例（2%）患者有肌瘤和平滑肌瘤合并的复杂病理情况。报告有5例并发症：2例术中并发症和3例术后发热。1例手术转为剖腹手术。输血率为0%，平均估计失血量为77毫升。恢复工作或正常活动的平均天数为10.1天。88.9%的患者报告性生活与手术前一样好或更好。所有患者均表示对该手术满意。
本系列中的LSH手术为子宫较大的患者提供了一种有效、低发病率的子宫切除替代方法。由于降低接受子宫切除术女性的发病率和改善护理质量是所有妇科医生的目标，我们认为LSH是一种应被考虑的替代方法。
