Chen Szu-yu, Chang Daw-Yuan, Sheu Bor-Ching, Torng Pao-Ling, Huang Su-Cheng, Hsu Wen-Chiung, Chang Wen-Chun
Department of Obstetrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
J Minim Invasive Gynecol. 2008 Sep-Oct;15(5):559-65. doi: 10.1016/j.jmig.2008.06.002. Epub 2008 Jul 26.
To estimate whether laparoscopic in situ morcellation (LISM) can facilitate laparoscopic-assisted vaginal hysterectomy (LAVH) for large uteri.
Prospective study (Canadian Task Force classification II-1).
University-affiliated hospital.
In all, 147 women with myoma or adenomyosis weighing more than 500 g from January 2004 through December 2007 were enrolled. The patients were divided into 4 subgroups: patients with uteri weighing 500 to 749 g who had traditional LAVH without LISM (group 1A, n=69) or with LISM (group 1B, n=16); and patients with uteri weighing 750 g or more who were treated by traditional LAVH without LISM (group 2A, n=38) or with LISM (group 2B, n=24).
Laparoscopic-assisted vaginal hysterectomy with or without LISM.
No significant differences existed in age, body mass index, preoperative diagnoses, complications, or duration of hospital stay among groups. The mean uterine weights were 608+/-75, 597+/-66, 989+/-179, and 935+/-226 g for groups 1A, 1B, 2A, and 2B, respectively. The operative time (120+/-16 vs 157+/-36 minutes, p<.001; 140+/-19 vs 224+/-57 minutes, p<.001) were significantly shorter in patients with LISM than without in both groups 1 and 2. The estimated blood loss was highest in group 2A. Six (16%) patients lost more than 500 mL of blood and 3 (8%) of them needed blood transfusions. Conversion to laparotomy occurred in 1 (2.6%) of 38 patients in group 2A. No repeated surgery or surgical mortality occurred.
Laparoscopic-assisted vaginal hysterectomy with LISM was an efficient and safe procedure for removal of large uteri during LAVH.
评估腹腔镜原位粉碎术（LISM）是否有助于腹腔镜辅助阴式子宫切除术（LAVH）治疗大子宫。
前瞻性研究（加拿大工作组分类II - 1）。
大学附属医院。
2004年1月至2007年12月期间，共纳入147例患有肌瘤或子宫腺肌病且子宫重量超过500克的女性。患者分为4个亚组：子宫重量为500至749克且接受无LISM的传统LAVH的患者（1A组，n = 69）或接受有LISM的传统LAVH的患者（1B组，n = 16）；子宫重量为750克及以上且接受无LISM的传统LAVH的患者（2A组，n = 38）或接受有LISM的传统LAVH的患者（2B组，n = 24）。
有或无LISM的腹腔镜辅助阴式子宫切除术。
各亚组间在年龄、体重指数、术前诊断、并发症或住院时间方面无显著差异。1A组、1B组、2A组和2B组的平均子宫重量分别为608±75、597±66、989±179和935±226克。在第1组和第2组中，有LISM的患者手术时间（分别为120±16 vs 157±36分钟，p <.001；140±19 vs 224±57分钟，p <.001）均显著短于无LISM的患者。估计失血量在2A组中最高。6例（16%）患者失血量超过500毫升，其中3例（8%）需要输血。2A组38例患者中有1例（2.6%）转为开腹手术。未发生再次手术或手术死亡。
在LAVH中，采用LISM的腹腔镜辅助阴式子宫切除术是一种切除大子宫的有效且安全的手术方法。
