Winner Brooke, Porter Anne, Velloze Stephanie, Biest Scott
Department of Obstetrics & Gynecology, Washington University in St. Louis, St. Louis, Missouri.
Obstet Gynecol. 2015 Oct;126(4):834-838. doi: 10.1097/AOG.0000000000001039.
To compare perioperative outcomes of uncontained and contained power morcellation in total laparoscopic hysterectomy.
Women who underwent total laparoscopic hysterectomy that required utilization of power morcellation between July 2012 and January 2015 in the Division of Minimally Invasive Gynecology at an academic tertiary care center were included. In February 2014, the division began performing all power morcellation contained within a large insufflated bag in an attempt to reduce dissemination of benign and malignant uterine tissue. Data were collected from a prospective database and analyzed as a retrospective cohort. The primary outcome was operative time. Secondary outcomes included estimated blood loss, length of stay, pathology, uterine weight, and complications, including blood transfusion, conversion to open, intraoperative organ injury, pelvic infection, readmission, or reoperation.
A total of 152 patients were identified: 101 uncontained morcellations and 51 contained morcellations. The baseline demographic characteristics between the two groups were similar. Operative time was longer in the contained morcellation group (184 compared with 164 minutes, P=.01). There were no cases of visible bag disruption or dissemination of uterine tissue in the contained morcellation group.
Contained power morcellation at the time of total laparoscopic hysterectomy is associated with a 20-minute increase in operative time when compared with uncontained morcellation.
II.
比较全腹腔镜子宫切除术中非封闭性和封闭性动力旋切术的围手术期结果。
纳入2012年7月至2015年1月在一家学术性三级医疗中心的微创妇科接受全腹腔镜子宫切除术且需要使用动力旋切术的女性患者。2014年2月，该科室开始在一个充入大量气体的大袋子内进行所有动力旋切术，以试图减少良性和恶性子宫组织的播散。数据从一个前瞻性数据库中收集，并作为回顾性队列进行分析。主要结局是手术时间。次要结局包括估计失血量、住院时间、病理、子宫重量以及并发症，包括输血、转为开腹手术、术中器官损伤、盆腔感染、再次入院或再次手术。
共确定了152例患者：101例非封闭性旋切术和51例封闭性旋切术。两组之间的基线人口统计学特征相似。封闭性旋切术组的手术时间更长（分别为184分钟和164分钟，P = 0.01）。封闭性旋切术组没有可见的袋子破裂或子宫组织播散的病例。
与非封闭性旋切术相比，全腹腔镜子宫切除术中的封闭性动力旋切术会使手术时间增加20分钟。
II级。
