Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
Obstet Gynecol. 2012 Sep;120(3):516-23. doi: 10.1097/AOG.0b013e318264f848.
To investigate the risk of vaginal cuff dehiscence after different routes of hysterectomy and methods of cuff closure.
A multi-institutional analysis of 12,398 patients who underwent hysterectomy for both benign and malignant disease between 1994 and 2008 was performed. We analyzed how different routes of hysterectomy and approaches to cuff suture may influence the risk of development of vaginal dehiscence.
Women who had total laparoscopic (n=3,573), abdominal (n=4,291), and vaginal (n=4,534) hysterectomies experienced 23 (0.64%), 9 (0.2%), and 6 (0.13%) cases of vaginal cuff dehiscence, respectively. Total laparoscopic hysterectomy was associated with a higher incidence of cuff separations, compared with abdominal hysterectomy (0.64% compared with 0.21%, P=.003) and vaginal hysterectomy (0.64% compared with 0.13%, P<.001). Within the endoscopic group, patients who underwent vaginal closure with laparoscopic knots had a higher rate of cuff dehiscence than patients who had suture with transvaginal knots (20 of 2,332 [0.86%] compared with 3 of 1,241 [0.24%], P=.028). When vaginal suture was performed transvaginally, no statistical difference in vaginal cuff dehiscence rate was observed compared with both abdominal hysterectomy (0.24% compared with 0.21%, P=.83) and vaginal hysterectomy (0.24% compared with 0.13%, P=.38). Use of monopolar energy at the time of colpotomy and reducing the power of monopolar energy from 60 watts to 50 watts when colpotomy was performed at the end of total laparoscopic hysterectomy did not alter the rate of cuff separations.
Transvaginal suturing appears to reduce the risk of vaginal dehiscence after total laparoscopic hysterectomy.
探讨不同子宫切除术路径和缝合方法对阴道残端裂开的风险。
对 1994 年至 2008 年间因良性和恶性疾病行子宫切除术的 12398 例患者进行多机构分析。我们分析了不同子宫切除术路径和缝合方法如何影响阴道残端裂开的风险。
行全腹腔镜（n=3573）、经腹（n=4291）和经阴道（n=4534）子宫切除术的患者中，阴道残端裂开分别为 23（0.64%）、9（0.2%）和 6（0.13%）例。与经腹子宫切除术（0.64%比 0.21%，P=.003）和经阴道子宫切除术（0.64%比 0.13%，P<.001）相比，全腹腔镜子宫切除术与阴道残端分离的发生率更高。在腹腔镜组中，阴道缝合采用腹腔镜结的患者阴道残端裂开率高于阴道缝合采用经阴道结的患者（2332 例中有 20 例[0.86%]比 1241 例中有 3 例[0.24%]，P=.028）。经阴道行阴道缝合时，阴道残端裂开率与经腹子宫切除术（0.24%比 0.21%，P=.83）和经阴道子宫切除术（0.24%比 0.13%，P=.38）相比无统计学差异。在阴道切开时使用单极电凝，以及在全腹腔镜子宫切除术结束时将阴道切开的单极电凝功率从 60 瓦降低至 50 瓦，并未改变残端分离的发生率。
经阴道缝合似乎降低了全腹腔镜子宫切除术后阴道残端裂开的风险。
