Boukerrou M, Lambaudie E, Collinet P, Crépin G, Cosson M
Pôle de chirurgie gynécologique, hôpital Jeanne-de-Flandre, centre hospitalier régional universitaire de Lille, 2, avenue Oscar-Lambret, 59037 Lille, France.
Gynecol Obstet Fertil. 2004 Jun;32(6):490-5. doi: 10.1016/j.gyobfe.2004.04.002.
We describe the intra and postoperative frequency of complications in vaginal hysterectomies for benign disorders in patients with a history of caesarean section.
Since 1996, 963 hysterectomies have been performed in our institution. 76.94% were performed exclusively by vaginal route (n = 741), 10.1% (n = 98) were by laparoscopic-assisted vaginal route and 12.9%, by pure abdominal route. We compared two groups of patients who underwent vaginal hysterectomy, with or without history of caesarean section. In each group we recorded the characteristics of the population and compared the intra and postoperative data, such as bladder or digestive tract wounds and haemorrhages. We used analysis of variance tests to compare means, chi2-tests and Fisher's exact tests for comparisons of numbers. A probability of P < 0.05 was adopted as the limit of significance.
The frequency of haemorrhages was significantly higher in the patients with a history of caesareans. Bladder and intestine injury rates are significantly higher in the previous caesarean section group, but not significant for the bowel injuries. We compared the cumulative frequency of complications between the two groups. In the group with previous caesarean section, we recorded 18.3% of intra operative complications. In the group without history of caesarean section, we recorded 3.58% of complications. There is a significant difference between the cumulative frequency of complications in the two populations of patients in favour of the sub group without a history of caesarean scar (P < 0.0001).
A history of single or multiple previous caesarean section increases the intra operative risk in vaginal hysterectomies. The surgeon must take into account the history of caesarean section and be attentive to the previous operating time of the bladder and uterine region especially at the time of opening the anterior peritoneal cul-de-sac. Nevertheless, uterine scarring as a sequel to caesareans must not be a contraindication to the vaginal route.
我们描述了有剖宫产史的患者因良性疾病行阴道子宫切除术时术中及术后并发症的发生率。
自1996年以来，我们机构共进行了963例子宫切除术。其中76.94%（n = 741）仅通过阴道途径进行，10.1%（n = 98）通过腹腔镜辅助阴道途径进行，12.9%通过单纯腹部途径进行。我们比较了两组行阴道子宫切除术的患者，一组有剖宫产史，另一组无剖宫产史。在每组中，我们记录了患者的特征，并比较了术中及术后的数据，如膀胱或消化道损伤及出血情况。我们使用方差分析检验比较均值，使用卡方检验和费舍尔精确检验比较数量。采用P < 0.05作为显著性界限。
有剖宫产史的患者出血发生率显著更高。膀胱和肠道损伤率在前次剖宫产组中显著更高，但肠道损伤差异不显著。我们比较了两组并发症的累积发生率。在前次剖宫产组中，我们记录到术中并发症发生率为18.3%。在无剖宫产史组中，我们记录到并发症发生率为3.58%。两组患者并发症累积发生率之间存在显著差异，无剖宫产瘢痕的亚组更有利（P < 0.0001）。
单次或多次剖宫产史会增加阴道子宫切除术的术中风险。外科医生必须考虑剖宫产史，并特别注意膀胱和子宫区域的既往手术时间，尤其是在打开前腹膜陷凹时。然而，剖宫产导致的子宫瘢痕不应成为阴道途径的禁忌证。
