Malinowski Andrzej, Makowska Justyna, Antosiak Beata
Klinika Ginekologii Operacyjnej i Endoskopowej, Instytutu Centrum Zdrowia Matki Polki w Łodzi, Polska.
Ginekol Pol. 2013 Apr;84(4):252-7. doi: 10.17772/gp/1572.
Hysterectomy is one of the most common gynecological procedures. Development of modern laparoscopic techniques made it a crucial tool in contemporary gynecology both in diagnosis and treatment. Increasing experience and improved laparoscopic instruments enabled gynecologists to extend indications for laparoscopic procedures as well as the range of the operation itself.
The analysis included peri- and postoperative data of 158 patients who underwent laparoscopic hysterectomy. Indication for hysterectomy and duration of operation were analyzed. Uterine volume, postoperative HB and HCT drop, time of hospital stay and complications were evaluated. In the study a description of the method of laparoscopic hysterectomy was presented.
Mean time of procedure was 68 min. (58-135 min.). Basing on operational protocols, the time of operation was measured from the moment laparoscopy started until the patient was fully awake after anesthesia. No adjustments were made for longer anesthetic recovery period. Estimated blood loss was 166.6 ml. Mean HB drop was 1.29 g/dl (0, 1-3 g/dl). Mean volume of the excised uterus was 108.24 cm3 (25.27-440.86 cm3). In 44 patients (27.84%) bilateral salpingo-oophorectomy was performed. In 4 cases (2.53%) there was an indication for postoperative antibiotics. None of the patients required blood transfusion or conversion to open surgery or the need to re-operate. Mean hospital stay after the surgery was 2.9 days. Overall, only 2 patients suffered long-term complications (1.26%): three weeks after the surgery urethro-vaginal fistulas occurred due to thermal injury to the ureter. That complication was noted during the first year of using this technique. Between 2008 and 2011 that type of adverse effect was not reported.
The analysis included perioperative and postoperative data of 158 patients who underwent laparoscopic hysterectomy. Data suggest that patients benefit from this procedure which is safe, associated with short postoperative recovery time, minimal blood loss and low complication rate, as well as good plastic result. We recommend laparoscopic hysterectomy as an alternative to open hysterectomy in cases when it can be safely performed.
子宫切除术是最常见的妇科手术之一。现代腹腔镜技术的发展使其成为当代妇科诊断和治疗中的关键工具。经验的增加和腹腔镜器械的改进使妇科医生能够扩大腹腔镜手术的适应证以及手术本身的范围。
1）展示接受腹腔镜子宫切除术患者的数据（尤其是围手术期数据）2）分析各种信息，包括：手术适应证、手术时长、对不同参数的评估，如：切除子宫的体积、术后血红蛋白（HB）和血细胞比容（HCT）下降情况、住院时间以及短期和长期并发症。
分析了158例行腹腔镜子宫切除术患者的围手术期和术后数据。分析了子宫切除术的适应证和手术时长。评估了子宫体积、术后HB和HCT下降情况、住院时间及并发症。研究中介绍了腹腔镜子宫切除术的方法。
平均手术时间为68分钟（58 - 135分钟）。根据手术记录，手术时间从腹腔镜开始至患者麻醉后完全清醒时测量。未对较长的麻醉恢复期进行调整。估计失血量为166.6毫升。平均HB下降1.29克/分升（0.1 - 3克/分升）。切除子宫的平均体积为108.24立方厘米（25.27 - 440.86立方厘米）。44例患者（27.84%）行双侧输卵管卵巢切除术。4例患者（2.53%）术后需要使用抗生素。无一例患者需要输血、转为开腹手术或再次手术。术后平均住院时间为2.9天。总体而言，仅2例患者出现长期并发症（1.26%）：术后三周因输尿管热损伤出现尿道阴道瘘。该并发症在使用该技术的第一年被发现。2008年至2011年未报告此类不良反应。
分析了158例行腹腔镜子宫切除术患者的围手术期和术后数据。数据表明患者从该手术中获益，该手术安全，术后恢复时间短，失血少，并发症发生率低，整形效果良好。我们建议在能够安全进行的情况下，腹腔镜子宫切除术可作为开腹子宫切除术的替代方法。
