Kho Rosanne M, Akl Mohamed N, Cornella Jeffrey L, Magtibay Paul M, Wechter Mary Ellen, Magrina Javier F
From the Department of Gynecologic Surgery, Mayo Clinic, Scottsdale, Arizona.
Obstet Gynecol. 2009 Aug;114(2 Pt 1):231-235. doi: 10.1097/AOG.0b013e3181af36e3.
To estimate the incidence and characteristics of patients with vaginal cuff dehiscence after robotic cuff closure.
We reviewed medical records from March 2004 to December 2008 of all patients with vaginal cuff dehiscence after a robotic simple and radical hysterectomy, trachelectomy, and upper vaginectomy using the robotic da Vinci Surgical System.
Twenty-one of 510 patients were identified with vaginal cuff dehiscence (incidence 4.1%, 95% confidence interval 2.3-5.8%). In nine patients, the robotic procedure was performed for a gynecologic malignancy. Coitus was the triggering event in 10 patients. Patients most commonly presented with vaginal bleeding and sudden gush of watery vaginal discharge. Bowel evisceration was associated in six patients. Median time to presentation was 43 days or 6.1 weeks. Nineteen cases were repaired through a vaginal approach and one combined vaginal and laparoscopic. Three of 21 patients experienced a repeat dehiscence and required a second repair.
Vaginal cuff dehiscence should be considered in patients with vaginal bleeding and sudden watery discharge after robotic cuff closure. The incidence is similar as previously reported for laparoscopic procedures. Contributing factors remain unknown but thermal effect and vaginal closure technique probably play major roles.
III.
评估机器人辅助阴道断端闭合术后阴道断端裂开患者的发生率及特征。
我们回顾了2004年3月至2008年12月期间，所有使用达芬奇机器人手术系统进行机器人辅助单纯性子宫切除术、根治性子宫切除术、宫颈切除术及上阴道切除术术后发生阴道断端裂开患者的病历。
510例患者中有21例发生阴道断端裂开（发生率4.1%，95%置信区间2.3 - 5.8%）。9例患者因妇科恶性肿瘤接受机器人手术。10例患者的诱发因素为性交。患者最常见的表现为阴道出血和突然涌出水样阴道分泌物。6例患者伴有肠管脱出。出现症状的中位时间为43天或6.1周。19例通过阴道途径修复，1例采用阴道联合腹腔镜修复。21例患者中有3例再次裂开，需要二次修复。
机器人辅助阴道断端闭合术后出现阴道出血和突然水样分泌物的患者应考虑阴道断端裂开。其发生率与先前报道的腹腔镜手术相似。相关因素尚不清楚，但热效应和阴道闭合技术可能起主要作用。
III级
