Billfeldt Nina K, Borgfeldt Christer, Lindkvist Håkan, Stjerndahl Jan-Henrik, Ankardal Maud
Department of Obstetrics and Gynecology, Regional Hospital of Halland, Halmstad, Sweden.
Department of Obstetrics and Gynecology, Skåne University Hospital, Lund University, Lund, Sweden.
Eur J Obstet Gynecol Reprod Biol. 2018 Mar;222:113-118. doi: 10.1016/j.ejogrb.2018.01.019. Epub 2018 Feb 3.
The aim was to evaluate surgical routes for benign hysterectomy in a Swedish population, including abdominal and minimally invasive surgery.
Prospectively collected data from the Swedish National GynOp Registry 2009-2015: 13 806 hysterectomy cases were included: abdominal (AH, n = 7485), vaginal (VH, n = 3767), conventional laparoscopic (LH, n = 1539) and robotically-assisted (RAH, n = 1015).
The VH group had the shortest operation time at 75 min, AH 97 min and RAH 104 min. LH was longest at 127 min (p < 0.005). The mean estimated blood loss was higher in the AH group (250 ml) compared to all minimally invasive surgery (MIS, 65-172 ml); p < 0.005). Conversion rates were 10% for LH, 4.8% for VH and 1.6% for RAH (p < 0.005). Hospitalization and patient-reported time to normal activities of daily living (ADL) were longer for AH compared to MIS (p < 0.005). Time to return to work was eight days longer in the AH group (35 days) compared with the MIS groups (p < 0.005). Complications were fewest in the VH group at 5.4% compared with AH 7.6% and RAH 8.7% (both p < 0.001), but did not significantly differ from the LH group at 6.6%. Overall patient satisfaction was reported to be 86-94% one year after surgery.
Women operated on for benign hysterectomy with minimally invasive methods in Sweden 2009-2015 had reduced length of hospitalization, as well as time to resuming normal ADL and return to work, compared to AH. Postoperative outcome measures were improved by minimally invasive methods and MIS should preferably be used.
评估瑞典人群中行良性子宫切除术的手术途径，包括开腹手术和微创手术。
前瞻性收集瑞典国家妇科手术登记处2009 - 2015年的数据：纳入13806例子宫切除术病例，包括开腹手术（AH，n = 7485）、经阴道手术（VH，n = 3767）、传统腹腔镜手术（LH，n = 1539）和机器人辅助手术（RAH，n = 1015）。
VH组手术时间最短，为75分钟，AH组为97分钟，RAH组为104分钟。LH组最长，为127分钟（p < 0.005）。AH组平均估计失血量（250毫升）高于所有微创手术组（MIS，65 - 172毫升）；p < 0.005）。LH组的中转率为10%，VH组为4.8%，RAH组为1.6%（p < 0.005）。与MIS相比，AH组的住院时间和患者报告的恢复正常日常生活（ADL）的时间更长（p < 0.005）。AH组恢复工作的时间比MIS组长8天（35天）（p < 0.005）。VH组并发症最少，为5.4%，AH组为7.6%，RAH组为8.7%（均p < 0.001），但与LH组的6.6%无显著差异。据报告，术后一年患者总体满意度为86 - 94%。
与开腹手术相比，2009 - 2015年在瑞典接受良性子宫切除术的女性采用微创手术，住院时间、恢复正常ADL和恢复工作的时间均缩短。微创手术改善了术后结局指标，应优先使用MIS。
