Giraudet G, Lucot J P, Sanz F, Rubod C, Collinet P, Cosson M
Department of Gynecological Surgery, Jeanne-de-Flandre Hospital, Regional University Hospital of Lille, avenue Eugène-Avinée, 59000 Lille, France.
Department of Gynecological Surgery, Jeanne-de-Flandre Hospital, Regional University Hospital of Lille, avenue Eugène-Avinée, 59000 Lille, France; Department of Gynecology and Obstetrics, Hospital of Bethune, 27, rue Delbecque, 62131 Verquigneul, France.
J Gynecol Obstet Hum Reprod. 2017 May;46(5):399-404. doi: 10.1016/j.jogoh.2017.03.007. Epub 2017 Mar 31.
The aim of our study was to evaluate the feasibility of vaginal hysterectomy in an ambulatory care system and the best way to perform it between conventional and bipolar vessel sealing system ligatures.
This was a prospective study of 32 patients with vaginal hysterectomy at Lille University Hospital between December 2013 and May 2015. Two surgical techniques were compared: conventional suture ligature (CSL) and electrosurgical bipolar vessel sealing (BVS). Patients stayed in classical hospitalization but were managed how if they were in an ambulatory unit to evaluate their capacity to come back home the same evening of the surgery. The evaluation of same-day discharge was based on Post Anesthetic Discharge Scoring System (PADSS) score?9/10 and Visual Analogic Scale (VAS) score?4/10. Other data collected were: operative time, uterus weight, peroperative bleeding, PADSS score at the 8th postoperative hour, VAS score at the 4th, 6th, 8th, 12th and 24th postoperative hours, the presence of postoperative nausea/vomiting and rehospitalization.
In the BVS group, 93.8% of patients validated the combined score (PADSS+VAS) on the evening of the intervention against 50% of patients in the CSL group (P<0.05). Hundred percent of BVS group patients were discharged on the day after surgery against 87.5% in the CSL group. The VAS was significantly lower in the BVS group at the 8th (1.4), 12th (1.2) and 24th (1.3) postoperative hours. Operative time was significantly shorter in the BVS group. We found more events such as nausea/vomiting in the CSL group.
Vaginal hysterectomy is feasible in an ambulatory care system most of times. By reducing postoperative pain, electrosurgical bipolar vessel sealing would promote outpatient hospitalization.
本研究旨在评估在门诊护理系统中进行阴道子宫切除术的可行性，以及在传统结扎与双极血管封闭系统结扎之间进行该手术的最佳方式。
这是一项对2013年12月至2015年5月间在里尔大学医院接受阴道子宫切除术的32例患者的前瞻性研究。比较了两种手术技术：传统缝扎术（CSL）和电外科双极血管封闭术（BVS）。患者接受传统住院治疗，但按照门诊单元的方式进行管理，以评估其在手术当晚回家的能力。当日出院评估基于麻醉后出院评分系统（PADSS）评分≥9/10和视觉模拟量表（VAS）评分≤4/10。收集的其他数据包括：手术时间、子宫重量、术中出血、术后8小时的PADSS评分、术后4、6、8、12和24小时的VAS评分、术后恶心/呕吐的发生情况以及再次住院情况。
在BVS组中，93.8%的患者在干预当晚通过了综合评分（PADSS+VAS），而CSL组为50%（P<0.05）。BVS组100%的患者在术后第一天出院，而CSL组为87.5%。BVS组在术后8小时（1.4）、12小时（1.2）和24小时（1.3）的VAS评分显著更低。BVS组的手术时间显著更短。我们发现CSL组出现更多诸如恶心/呕吐等情况。
大多数情况下，阴道子宫切除术在门诊护理系统中是可行的。通过减轻术后疼痛，电外科双极血管封闭术将促进门诊住院治疗。
