Chang Wen-Chun, Huang Su-Cheng, Sheu Bor-Ching, Torng Pao-Ling, Hsu Wen-Chiung, Chen Szu-Yu, Chang Daw-Yuan
Department of Obstetrics and Gynecology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
Acta Obstet Gynecol Scand. 2008;87(5):558-63. doi: 10.1080/00016340802011587.
To study if there are specific problems in laparoscopically assisted vaginal hysterectomy (LAVH) for a certain weight of bulky uteri and the strategies to overcome such problems.
One hundred and eighty-one women with myoma or adenomyosis, weighing 350-1,590 g, underwent LAVH between August 2002 and December 2005. Key surgical strategies were special sites for trocar insertion, uterine artery or adnexal collateral pre-ligation, laparoscopic and transvaginal volume reduction technique. The basic clinical and operative parameters were recorded for analysis.
Based on significant differences in the operative time and estimated blood loss, the patients were divided into medium uteri weighing 350-749 g, n=138 (76%), and large uteri weighing > or =750 g, n=43 (24%). There was no significant difference in terms of age, body mass index, preoperative diagnoses, complications and duration of hospital stay among groups. The operative time and estimated blood loss increased with larger uterine size (p<0.001). The operative time (196+/-53, 115-395 min), estimated blood loss (234+/-200, 50-1,000 ml) and frequency of excessive bleeding (14%) or transfusion (5%) were significantly greater, but in acceptable ranges, for those with large uteri. Conversion to laparotomy was required in a patient (2%) with a large uterus, and the overall conversion rate was 0.6%. There was no re-operation or surgical mortality.
Using various combinations of special strategies, most experienced gynecologic surgeons can conduct LAVH for most large uteri with minimal rates of complications and conversion to laparotomy.
研究对于特定重量的巨大子宫，腹腔镜辅助阴式子宫切除术（LAVH）是否存在特殊问题以及克服这些问题的策略。
2002年8月至2005年12月期间，181例患有肌瘤或腺肌病、子宫重量在350 - 1590克的女性接受了LAVH。关键手术策略包括套管针插入的特殊部位、子宫动脉或附件侧支预结扎、腹腔镜和经阴道体积缩小技术。记录基本临床和手术参数进行分析。
根据手术时间和估计失血量的显著差异，患者被分为中等大小子宫组（350 - 749克，n = 138，76%）和大子宫组（≥750克，n = 43，24%）。两组在年龄、体重指数、术前诊断、并发症和住院时间方面无显著差异。手术时间和估计失血量随子宫增大而增加（p < 0.001）。大子宫患者的手术时间（196 ± 53，115 - 395分钟）、估计失血量（234 ± 200，50 - 1000毫升）以及大出血（14%）或输血（5%）的发生率显著更高，但仍在可接受范围内。1例大子宫患者（2%）需要转为开腹手术，总体转换率为0.6%。无再次手术或手术死亡情况。
通过各种特殊策略的组合，大多数经验丰富的妇科医生可以对大多数大子宫进行LAVH，并发症发生率和转为开腹手术的比例最低。
