Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
J Minim Invasive Gynecol. 2012 Jan-Feb;19(1):89-94. doi: 10.1016/j.jmig.2011.10.003. Epub 2011 Nov 30.
To compare intraoperative hemorrhage and other operative parameters after laparoscopically assisted vaginal hysterectomy (LAVH) versus total abdominal hysterectomy (TAH) for benign gynecologic conditions.
A prospective, randomized, controlled trial.
Between April 2010 and March 2011, 50 Thai patients with strong indications for hysterectomy--with uterine sizes ≤16 weeks of gravid uterus and with no contraindications for open or laparoscopic surgeries--were randomly assigned for LAVH or TAH.
Intraoperative blood loss, operating time, postoperative analgesic requirements, perioperative complications, and duration of hospitalization.
Intraoperative blood loss was significantly less in the LAVH group (median 120 mL [range 50-300]) than in the TAH group (median 250 mL [105-800]) (median difference 130 mL, p <.001, 95% confidence interval [CI] 55-200). The LAVH group required significantly less postoperative morphine sulfate administration (median 3 mg [range 0-12]) than the TAH group (15 mg [6-24]) (median difference 9 mg, p <.001, 95% CI 9-12). The hospital stay for the LAVH group (median 3 days; range 2-7) was significantly shorter than that of the TAH group (median 4 days; range 4-5) (median difference 2 days, p <.001, 95% CI 1-2). The operating time was comparable between the 2 groups (median 100 minutes; range 50-240) for the LAVH and 115 minutes (range 60-200) for the TAH group (median difference 5 minutes, p =.592, 95% CI -15-25). There were no conversions from a LAVH to a laparotomy.
The LAVH has advantages over the TAH in that in the former there is less intraoperative blood loss, less postoperative morphine requirement, and a shorter duration of postoperative hospital stays.
比较腹腔镜辅助阴式子宫切除术（LAVH）与经腹全子宫切除术（TAH）治疗良性妇科疾病的术中出血量和其他手术参数。
前瞻性、随机、对照试验。
2010 年 4 月至 2011 年 3 月，50 例泰国患者因强烈要求子宫切除术而被纳入研究，这些患者子宫大小≤妊娠 16 周大小，且无开腹或腹腔镜手术禁忌证，他们被随机分配行 LAVH 或 TAH。
术中出血量、手术时间、术后镇痛需求、围手术期并发症和住院时间。
LAVH 组术中出血量明显少于 TAH 组（中位数 120 mL [范围 50-300] 比 250 mL [中位数 105-800]）（中位数差值 130 mL，p <.001，95%置信区间 [CI] 55-200）。LAVH 组术后硫酸吗啡的使用量明显少于 TAH 组（中位数 3 mg [范围 0-12] 比 15 mg [6-24]）（中位数差值 9 mg，p <.001，95% CI 9-12）。LAVH 组的住院时间（中位数 3 天；范围 2-7）明显短于 TAH 组（中位数 4 天；范围 4-5）（中位数差值 2 天，p <.001，95% CI 1-2）。两组手术时间相似（LAVH 组中位数 100 分钟；范围 50-240），TAH 组中位数 115 分钟（范围 60-200）（中位数差值 5 分钟，p =.592，95% CI -15-25）。无一例从 LAVH 转为剖腹手术。
与 TAH 相比，LAVH 具有术中出血量少、术后吗啡需求少、术后住院时间短的优势。
