Mothes Anke R, Schlachetzki Anja, Nicolaus Kristin, Vorwergk Julia, Lehmann Thomas, Radosa Marc P, Mothes Henning K, Runnebaum Ingo B
Department of Gynecology and Reproductive Medicine, University Women's Hospital Jena, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany.
Institute of Medical Statistics, Informatics and Documentation, University Hospital, Friedrich-Schiller-University Jena, Jena, Germany.
Arch Gynecol Obstet. 2018 Dec;298(6):1131-1137. doi: 10.1007/s00404-018-4909-z. Epub 2018 Oct 10.
This comparative cohort study evaluated the influence of surgical route for prolapse hysterectomy (vaginal or laparoscopically assisted) on the achievement of intended elective salpingo-oophorectomy, which was a procedural goal planned with the patient before primary vaginal native-tissue prolapse surgery.
Consecutive patients who underwent total vaginal hysterectomy (TVH; n = 163) or laparoscopically assisted vaginal hysterectomy (LAVH; n = 144) and vaginal native-tissue repair for pelvic organ prolapse at Jena University Hospital were enrolled.
Peri- and postoperative parameters, including Clavien-Dindo (CD) classification of surgical complications, were compared between groups using Student's t test, Fisher's exact test, and multivariable regression. Patient characteristics were similar, except that grade IV prolapse was more common in the LAVH group (p < 0.001). The following parameters differed between the TVH and LAVH groups: concomitant salpingectomy (1.2% vs. 34%) and salpingo-oophorectomy (45% vs. 66%), non-performance of intended salpingo-oophorectomy (36% vs. 0% OR 0.006, 95% CI < 0.001-0.083), adhesiolysis (0% vs. 44%), CD II-III complications (51% vs. 14.6% p < 0.001), operating time (153 ± 61 vs. 142 ± 27 min), and postoperative in-patient days (9.02 ± 4.9 vs. 4.99 ± 0.96; all p < 0.001).
LAVH enabled the safe performance of planned concomitant salpingo-oophorectomy in all cases. To achieve the procedural goal in such cases, laparoscopic assistance in prolapse hysterectomy should be considered.
本比较队列研究评估了脱垂子宫切除术的手术途径（经阴道或腹腔镜辅助）对实现预期选择性输卵管卵巢切除术的影响，这是在原发性阴道固有组织脱垂手术前与患者计划的一项手术目标。
纳入了在耶拿大学医院接受全阴道子宫切除术（TVH；n = 163）或腹腔镜辅助阴道子宫切除术（LAVH；n = 144）以及盆腔器官脱垂阴道固有组织修复术的连续患者。
使用学生t检验、Fisher精确检验和多变量回归对两组之间的围手术期和术后参数进行比较，包括手术并发症的Clavien-Dindo（CD）分类。患者特征相似，除了IV级脱垂在LAVH组中更常见（p < 0.001）。TVH组和LAVH组之间的以下参数存在差异：同期输卵管切除术（1.2%对34%）和输卵管卵巢切除术（45%对66%）、未进行预期的输卵管卵巢切除术（36%对0%，OR 0.006，95%CI < 0.001 - 0.083）、粘连松解术（0%对44%）、CD II - III级并发症（51%对14.6%，p < 0.001）、手术时间（153 ± 61对142 ± 27分钟）以及术后住院天数（9.02 ± 4.9对4.99 ± 0.96；所有p < 0.001）。
LAVH能够在所有病例中安全地进行计划的同期输卵管卵巢切除术。为了在这类病例中实现手术目标，应考虑在脱垂子宫切除术中采用腹腔镜辅助。
