Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
Menopause. 2010 Jan-Feb;17(1):96-103. doi: 10.1097/gme.0b013e3181ade901.
The aim of this study was to analyze temporal trends in adoption of laparoscopy in a cohort of older women (> or =70 y) undergoing gynecologic abdominal procedures and to assess operative outcomes compared with those of open procedures.
A prospective entered database was queried for all women aged 70 years or older undergoing surgery at our department during a 9-year period. Surgical outcomes were compared according to the type of surgical approach (laparoscopy vs open) and assessed over time.
Two-hundred thirty-one women were identified. Of these, 116 underwent laparoscopic procedures, and 115 had open abdominal surgery. The study groups were similar with regard to demographics and preoperative variables. Conversion to laparotomy due to intervening complications occurred in one case (0.9%). Among women with early-stage gynecologic malignancies, overall and postoperative complications were lower in the laparoscopy group than in the open surgery group. Estimated blood loss and hospital stay were lower in the laparoscopy group than in the open surgery group, for both benign and malignant conditions. The annual proportion of laparoscopic cases has increased significantly during the study period from 12% in 2001 to 79.3% in 2007 (P for trend < 0.0001). No difference was found in operative time, number of lymph nodes harvested, and complication rates, when data of subsequent time periods were compared.
Older women who undergo laparoscopy have a significantly shorter hospitalization and fewer complications compared with older women who undergo open surgery. Laparoscopy should be considered in all women in whom a gynecologic abdominal procedure is planned regardless of age.
本研究旨在分析在一个 70 岁以上（≥70 岁）接受妇科腹部手术的老年女性队列中腹腔镜手术应用的时间趋势，并与开放手术的手术结果进行比较。
在 9 年期间，我们科室对所有 70 岁或以上接受手术的女性进行前瞻性登记数据库查询。根据手术方式（腹腔镜与开放）比较手术结果，并随时间进行评估。
确定了 231 名女性。其中 116 例行腹腔镜手术，115 例行开腹手术。研究组在人口统计学和术前变量方面相似。由于介入并发症，有 1 例（0.9%）转为剖腹手术。对于早期妇科恶性肿瘤的女性，腹腔镜组的总体并发症和术后并发症低于开腹手术组。腹腔镜组的失血量和住院时间均低于开腹手术组，良性和恶性疾病均如此。在研究期间，腹腔镜手术的年度比例从 2001 年的 12%显著增加到 2007 年的 79.3%（趋势 P<0.0001）。当比较后续时间段的数据时，手术时间、淋巴结采集数量和并发症发生率没有差异。
与接受开放手术的老年女性相比，接受腹腔镜手术的老年女性的住院时间明显缩短，并发症也更少。对于计划进行妇科腹部手术的所有女性，无论年龄大小，均应考虑腹腔镜手术。
