Shrestha N S, Saha R, Karki C
Department of Ob/Gyn, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal.
Nepal Med Coll J. 2010 Sep;12(3):176-9.
Hysterectomy is one of the most frequently performed major surgical procedure in women. Traditionally, the uterus has been removed either by abdominal or vaginal route. In spite of the recommendations in favor of vaginal hysterectomy majority of the hysterectomies are still done by the means of abdominal route and vaginal route is utilized mostly for prolapsed uterus. This study was done to see the current trend of routes of hysterectomy for benign condition at Kathmandu Medical College Teaching Hospital and its indication. This was a cross-sectional and comparative study done for 24 months (Jan 2008- Dec 2009). Data for the year 2009 was collected prospectively and for the year 2008 case notes of all the cases of hysterectomy was reviewed. Total 317 cases of hysterectomy were done for benign condition in KMCTH during the 2 year study period. Of the 317 cases 124 was done during the year 2008 and 193 during 2009. Three major route namely vaginal hysterectomy (VH), Abdominal Hysterectomy (AH), and Laparoscopic hysterectomy (LH) was utilized for performing hysterectomy. Major indication for hysterectomy was pelvic organ prolapse (POP) followed by abnormal uterine bleeding (AUB), and fibroid uterus during both the years. Route of hysterectomy in the cases with non prolapsed pelvic organ were AH (94.0%) and LH (6.0%) during the year 2008 and VH (6.0%), AH (76%) and LH (18.0%) during the year 2009. Major indications for hysterectomy are POP, AUB, and fibroid uterus. VH is mainly done for the cases of POP. AH is still the major route for indications other than POP. Minimally invasive approach like VH for non descent uterus and LH although is rising needs to be practiced more.
子宫切除术是女性中最常施行的大型外科手术之一。传统上，子宫切除通过腹部或阴道途径进行。尽管有建议支持阴道子宫切除术，但大多数子宫切除术仍通过腹部途径进行，阴道途径主要用于子宫脱垂。本研究旨在观察加德满都医学院教学医院良性疾病子宫切除途径的当前趋势及其适应证。这是一项为期24个月（2008年1月至2009年12月）的横断面比较研究。前瞻性收集了2009年的数据，并回顾了2008年所有子宫切除病例的病历。在为期2年的研究期间，加德满都医学院教学医院共进行了317例良性疾病子宫切除术。其中，2008年进行了124例，2009年进行了193例。子宫切除术采用了三种主要途径，即阴道子宫切除术（VH）、腹部子宫切除术（AH）和腹腔镜子宫切除术（LH）。两年中子宫切除的主要适应证均为盆腔器官脱垂（POP），其次是异常子宫出血（AUB）和子宫肌瘤。2008年，非脱垂盆腔器官病例的子宫切除途径为AH（94.0%）和LH（6.0%）；2009年为VH（6.0%）、AH（76%）和LH（18.0%）。子宫切除主要适应证为POP、AUB和子宫肌瘤。VH主要用于POP病例。除POP外，AH仍是其他适应证的主要途径。对于非脱垂子宫，像VH这样的微创方法以及LH虽然正在增加，但仍需更多应用。
