Walsh Teresa M, Sangi-Haghpeykar Haleh, Ng Vicky, Zurawin Robert, Guan Xiaoming
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX.
Department of Obstetrics and Gynecology, St. Luke's Women's Center, San Francisco, CA.
J Minim Invasive Gynecol. 2015 Nov-Dec;22(7):1231-6. doi: 10.1016/j.jmig.2015.06.022. Epub 2015 Jul 8.
To determine whether laparoscopic hand-assisted hysterectomy for a large uterus had different surgical outcomes compared with traditional open hysterectomy.
Retrospective cohort study (Canadian Task Force classification II-2).
Academic tertiary care hospital.
Women who had undergone laparoscopic hand-assisted hysterectomy for a large uterus were included as the hand-assist group. The control group comprised patients with similar final specimen weight (>1 kg), characteristics (body mass index, age), and surgical history, who underwent open hysterectomy for a large uterus.
Laparoscopic hysterectomy using a hand-assist port for laparoscopic portion of the case.
The 2 groups were similar in terms of specimen weight (median, 1765.5 g for hand-assist vs 1215.50 g for controls; p = .29). In univariate analysis, the median operating time was longer in the hand-assist group compared with controls (241.5 minutes vs 185.0 minutes; p = .002), whereas median length of stay was shorter in the hand-assist group (1.0 day vs 3.0 days; p < .0001). These differences remained significant after adjustment for potential confounders in multivariable analysis (p < .05). There was no difference in estimated blood loss (p > .05) between the 2 groups, although the change in hemoglobin was less in the hand-assist group compared with controls in multivariable analysis (adjusted mean.74 vs. 1.8; p = .04). Complications were divided into intraoperative complications (transfusion, consultation, bowel injury, bladder injury, ureter injury, and other), hospital postoperative complications (reoperation, transfusion, slow return of bowel function, ileus, poor pain control, fever of unknown origin, venous thromboembolism, pneumonia, and neuropathy), and complications after discharge (readmission, wound infection). The 2 groups had a similar low rate of complications (p > .05).
Laparoscopic hand-assist hysterectomy is a feasible alternative to open hysterectomy in patients with a large uterus.
确定对于大子宫患者，腹腔镜手辅助子宫切除术与传统开放性子宫切除术相比是否具有不同的手术结果。
回顾性队列研究（加拿大工作组分类II-2）。
学术性三级护理医院。
接受腹腔镜手辅助大子宫切除术的女性被纳入手辅助组。对照组包括最终标本重量相似（>1kg）、特征（体重指数、年龄）和手术史相似，接受开放性大子宫切除术的患者。
在腹腔镜部分手术中使用手辅助端口进行腹腔镜子宫切除术。
两组在标本重量方面相似（手辅助组中位数为1765.5g，对照组为1215.50g；p = 0.29）。在单因素分析中，手辅助组的中位手术时间比对照组长（241.5分钟对185.0分钟；p = 0.002），而手辅助组的中位住院时间较短（1.0天对3.0天；p < 0.0001）。在多因素分析中对潜在混杂因素进行调整后，这些差异仍然显著（p < 0.05）。两组间估计失血量无差异（p > 0.05），尽管在多因素分析中，与对照组相比，手辅助组血红蛋白的变化较小（调整后均值0.74对1.8；p = 0.04）。并发症分为术中并发症（输血、会诊、肠损伤、膀胱损伤、输尿管损伤及其他）、术后住院并发症（再次手术、输血、肠功能恢复缓慢、肠梗阻、疼痛控制不佳、不明原因发热、静脉血栓栓塞、肺炎和神经病变）以及出院后并发症（再次入院、伤口感染）。两组并发症发生率均较低且相似（p > 0.05）。
对于大子宫患者，腹腔镜手辅助子宫切除术是开放性子宫切除术的一种可行替代方法。
Zotero 插件