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采用腔内缝合的全腹腔镜子宫切除术（TLH）与使用能量源的传统技术的比较。

Total laparoscopic hysterectomy (TLH) with endosuturing compared with conventional technique using energy sources.

作者信息

Marwah V, Dutta S, Kedia S, Mittal P

出版信息

Facts Views Vis Obgyn. 2021 Jun;13(2):149-158. doi: 10.52054/FVVO.13.2.018.

DOI:10.52054/FVVO.13.2.018
PMID:34184844
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8291987/
Abstract

BACKGROUND

The aim of the study was to demonstrate the technique of total laparoscopic hysterectomy (TLH) with intra-corporeal endosuturing using simple sutures and basic surgical instruments and compare with TLH using electric coagulation equipment i.e. energy sources with regard to operative time, blood loss, postoperative stay and pain scores.

METHODS

A retrospective study was undertaken, in Max Super Specialty Hospital Saket, from June 2015 to May 2018, which included 586 cases of TLH (for benign gynecological conditions), of which 287 were performed using intra-corporeal endosuturing (Group 1) and 299 were performed using energy sources (Group 2). To avoid bias, baseline matching was done for body mass index (BMI), indications for surgery, size of uterus, previous abdominal surgeries and comorbidities like diabetes and hypertension after which there were 172 patients in each group.

RESULTS

The mean age of patients was 48.24 ± 6.76 years. All operative outcomes including operative time (104.1 ± 22.6 vs 107.6 ± 32.6 mins, p=0.25), blood loss (78.9 ± 101.6 vs 99.7 ± 177.6 ml, p=0.19), pain score (2.5 ± 1.3 vs 2.7 ± 1.2, p=0.13) and post-operative stay (2.05 ± 0.2 vs 2.07 ± 0.3 days, p=0.36) were similar between the two groups. Uterine size was the major determinant of operative time and operative blood loss.

CONCLUSION

TLH with intracorporeal endosuturing can be performed safely and gives results comparable with TLH performed using energy sources. Advancement in suturing devices can decrease operative time further and potentially make it easier and more acceptable.

摘要

背景

本研究的目的是演示使用简单缝线和基本手术器械进行体内缝合的全腹腔镜子宫切除术（TLH）技术，并与使用电凝设备（即能量源）的TLH在手术时间、失血、术后住院时间和疼痛评分方面进行比较。

方法

在萨克特马克斯超级专科医院进行了一项回顾性研究，时间从2015年6月至2018年5月，纳入586例TLH（用于良性妇科疾病），其中287例采用体内缝合（第1组），299例采用能量源（第2组）。为避免偏差，对体重指数（BMI）、手术指征、子宫大小、既往腹部手术以及糖尿病和高血压等合并症进行了基线匹配，之后每组有172例患者。

结果

患者的平均年龄为48.24±6.76岁。两组之间所有手术结果包括手术时间（104.1±22.6对107.6±32.6分钟，p = 0.25）、失血（78.9±101.6对99.7±177.6毫升，p = 0.19）、疼痛评分（2.5±1.3对2.7±1.2，p = 0.13）和术后住院时间（2.05±0.2对2.07±0.3天，p = 0.36）相似。子宫大小是手术时间和手术失血的主要决定因素。

结论

体内缝合的TLH可以安全进行，其结果与使用能量源进行的TLH相当。缝合设备的进步可以进一步缩短手术时间，并可能使其更容易被接受。

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