Grant-Orser Amanda, El Sugy Ramadan, Singh Sukhbir S
Department of Obstetrics and Gynaecology, The Ottawa Hospital, Ottawa ON.
Department of Obstetrics and Gynaecology, The Ottawa Hospital, Ottawa ON; Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, ON.
J Obstet Gynaecol Can. 2014 Mar;36(3):248-252. doi: 10.1016/S1701-2163(15)30633-2.
The minimally invasive surgical (MIS) approach to hysterectomy (vaginal or laparoscopic), when compared with laparotomy, results in shorter length of stay, fewer minor and major complications, and quicker return to normal activity. The complexity of the hysterectomy procedure or pathology may affect the success of an MIS approach. This study examined the indications, complications, and outcomes of all hysterectomies performed, irrespective of the severity of pathology or patient habitus, in a Canadian tertiary level gynaecologic surgical referral service.
We performed a retrospective chart review of all hysterectomies performed by a single surgeon between September 2007 and June 2011, noting indications, complications, and outcomes. One-way analysis of variance was used to calculate the influence of various factors across surgery types. Significance was set at P < 0.05 for all tests.
A total of 305 cases were included; 291 of these (95.4%) were managed through an MIS approach, providing a technicity rate of 95.4%. Mean patient age was 45.5 years, and mean BMI was 28.9. The main indicators for surgery were fibroids (42.0%), pain (38.4%), and heavy menstrual bleeding (37.4%). Eighty-one percent of cases were tertiary referrals. Of the laparoscopic cohort, endometriosis was moderate-severe in 61.2% of patients. Mean length of stay was 1.14 days, mean uterine weight was 277.6 g, and mean estimated blood loss was 179 mL.
This retrospective study of a tertiary level referral gynaecologic service suggests that complex hysterectomy may be effectively and efficiently managed through an MIS approach.
与剖腹手术相比，子宫切除术的微创外科手术（MIS）入路（阴道或腹腔镜）可缩短住院时间，减少轻微和严重并发症，并更快恢复正常活动。子宫切除术的程序或病理复杂性可能会影响MIS入路的成功率。本研究调查了加拿大一家三级妇科手术转诊服务机构中所有子宫切除术的适应证、并发症及手术结果，无论病理严重程度或患者体型如何。
我们对2007年9月至2011年6月期间由一名外科医生实施的所有子宫切除术进行了回顾性病历审查，记录适应证、并发症及手术结果。采用单因素方差分析计算不同手术类型中各种因素的影响。所有检验的显著性设定为P<0.05。
共纳入305例病例；其中291例（95.4%）采用MIS入路进行治疗，技术成功率为95.4%。患者平均年龄为45.5岁，平均BMI为28.9。手术的主要指征为子宫肌瘤（42.0%）、疼痛（38.4%）和月经过多（37.4%）。81%的病例为三级转诊。在腹腔镜手术组中，61.2%的患者患有中度至重度子宫内膜异位症。平均住院时间为1.14天，平均子宫重量为277.6 g，平均估计失血量为179 mL。
这项对三级转诊妇科服务的回顾性研究表明，复杂子宫切除术可通过MIS入路有效且高效地进行管理。
