Department of Obstetrics and Gynecology, Stony Brook University Medical Center, Stony Brook, New York.
Department of Obstetrics and Gynecology, Stony Brook University Medical Center, Stony Brook, New York.
J Minim Invasive Gynecol. 2014 Jan-Feb;21(1):109-14. doi: 10.1016/j.jmig.2013.06.008. Epub 2013 Jul 31.
To compare conversion rates, operative time, and estimated blood loss in patients undergoing mini-laparotomy (<4 cm vertical or transverse abdominal incision) versus laparoscopy for treatment of benign gynecologic conditions.
Retrospective study (Canadian Task Force classification II-2).
Academic medical center.
Women who underwent laparoscopy or mini-laparotomy for treatment of gynecologic conditions from January 2002 to March 2011. Patients who underwent hysterectomy as part of the surgery, cancer staging procedure, pregnancy-related procedure, or diagnostic surgery alone were excluded.
Mini-laparotomy or laparoscopy.
Primary outcomes were operative time and estimated blood loss. Secondary outcomes were hospital readmission, repeat operation, overnight hospital admission, emergency room visits because of surgery-related signs or symptoms, and wound complications. Of 950 medical records examined, 493 patients (52%) met the inclusion criteria, of which 141 (29%) underwent mini-laparotomy and 352 (71%) underwent laparoscopy. The groups had similar indications for surgery and level of surgical assistant. Patients who underwent mini-laparotomy were older than those who underwent laparoscopy. In patients who underwent mini-laparotomy, mean operative time was significantly shorter (49.3 versus 91.5 minutes; p = .003), and estimated blood loss was less (20 versus 32 mL; p = .001). The cumulative secondary outcome rate was not statistically different between the 2 groups (15% versus 16%). When each secondary outcome (conversion, repeat operation, overnight hospital admission, readmission to the hospitalization, emergency department visit, and wound complication) was examined independently, only the wound complication rate was significantly higher in the mini-laparotomy group compared with the laparoscopy group (5 of 141 patients versus 1 of 352 patients; p = .008).
Mini-laparotomy is a safe alternative to traditional minimally invasive approaches in gynecology and offers the additional benefits of shorter intraoperative time and less blood loss; however, it is associated with a significantly higher rate of major wound complications. Mini-laparotomy is an important surgical approach and should be included in gynecologic surgical training.
比较行小切口（<4cm 垂直或横向腹部切口）开腹术与腹腔镜手术治疗良性妇科疾病的中转率、手术时间和估计失血量。
回顾性研究（加拿大卫生保健研究与发展基金会分类 II-2 级）。
学术医疗中心。
2002 年 1 月至 2011 年 3 月期间因妇科疾病接受腹腔镜或小开腹手术治疗的女性。手术包括子宫切除术、癌症分期、妊娠相关手术或单纯诊断性手术的患者被排除在外。
小开腹术或腹腔镜手术。
主要结果为手术时间和估计失血量。次要结果为住院再入院、再次手术、住院过夜、因手术相关症状或体征而就诊急诊室和伤口并发症。在检查的 950 份病历中，493 名患者（52%）符合纳入标准，其中 141 名（29%）行小开腹术，352 名（71%）行腹腔镜手术。两组手术适应证和手术助手级别相似。行小开腹术的患者比行腹腔镜手术的患者年龄更大。行小开腹术的患者，手术时间明显缩短（49.3 分钟比 91.5 分钟；p =.003），估计失血量也更少（20 毫升比 32 毫升；p =.001）。两组的累积次要结局发生率无统计学差异（15%比 16%）。当分别检查每个次要结局（中转、再次手术、住院过夜、再次入院、急诊室就诊和伤口并发症）时，小开腹组的伤口并发症发生率明显高于腹腔镜组（5 例比 1 例；p =.008）。
小开腹术是妇科传统微创手术的一种安全替代方法，具有术中时间更短、失血量更少的额外优势；但它与更高的主要伤口并发症发生率相关。小开腹术是一种重要的手术方法，应纳入妇科手术培训中。
