Department of Obstetrics, Gynaecology, University of the Witwatersrand, Johannesburg, South Africa.
Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisbon, Portugal; Department of Obstetrics and Gynecology, NOVA Medical School, Faculdade de CiênciasMédicas, NOVA University of Lisbon, Lisbon, Portugal; Department of Obstetrics and Gynecology, Hospital CUF Descobertas, Lisbon, Portugal.
Eur J Obstet Gynecol Reprod Biol. 2021 Dec;267:73-78. doi: 10.1016/j.ejogrb.2021.10.018. Epub 2021 Oct 22.
The primary objectives of this study were to estimate blood loss, operation time and cost differences in patients undergoing vaginal hysterectomy (VH) versus laparoscopically-assisted vaginal hysterectomy (LAVH). The secondary objectives were to determine differences in hospital stay, need for postoperative analgesia, intra- and immediate post-operative complications, and the rate of conversion to laparotomy. VH was hypothesized to be the preferred route for hysterectomy for benign uterine conditions.
A randomized control study was undertaken at the Department of Obstetrics and Gynaecology of the Charlotte Maxeke Johannesburg Academic Hospital and included the women admitted between January 2017 and December 2019 for hysterectomy due to benign conditions, meeting the inclusion criteria (vaginally accessible uterus, estimated uterine size ≤ 12 weeks of gestation or ≤ 280 g on ultrasound examination and pathology confined to the uterus). Surgical procedures were performed by the residents in training under the supervision of specialists with large experience. The patient demographic characteristics, uterine weight, operative time, estimated blood loss(expressed as the difference between preoperative and postoperative day one serum haemoglobin),direct surgery-associated costs, intra- and immediate post-operative complications and the length of hospital stay were recorded and comparatively analysed among patients randomly placed in VH and LAVH group.
A total of 227 women were included (151 patients underwent VH and 76 LAVH, upon 2:1 randomization, performed on this way to reflect the previous pattern of operating of the unit). The patients were matched with respect to age, parity and body mass index. No significant differences between two groups were found in mean uterine weight and also in mean serum haemoglobin shift, intra- and immediate post-operative complications, and convalescence period duration. There were statistically significant differences in operating time and in cost between the two procedures. On average, LAVH took longer than VH to be performed (62.8 ± 9.3 vs 29.9 ± 6.6 min, p < 0.0001) and it was more costly, mainly due to the longer operating time and required disposables. An amount of 15698.20 South African Rand (ZAR) or 1145.85 United States Dollar (USD) more were needed to perform LAVH in comparison to VH. All VHs and LAVHs were successfully accomplished without major complications or conversation to laparotomy.
Our data indicate that VH is a feasible and safe alternative for a large group of women with benign pathology and non-prolapsed uteri, being a faster and less costly procedure than LAVH.
本研究的主要目的是估计行阴道子宫切除术（VH）与腹腔镜辅助阴道子宫切除术（LAVH）的患者的失血量、手术时间和成本差异。次要目的是确定住院时间、术后镇痛需求、术中及即刻术后并发症以及中转开腹率的差异。假设 VH 是治疗良性子宫疾病的首选途径。
这项随机对照研究在夏洛特·马克斯凯 Johannesburg 学术医院的妇产科进行，纳入 2017 年 1 月至 2019 年 12 月期间因良性疾病入院并符合纳入标准（阴道可触及子宫、估计子宫大小≤12 孕周或超声检查和病理学局限于子宫的≤280g）行子宫切除术的女性。手术由接受培训的住院医师在经验丰富的专家监督下进行。记录患者的人口统计学特征、子宫重量、手术时间、估计失血量（表示术前和术后第一天血清血红蛋白的差值）、直接手术相关成本、术中及即刻术后并发症以及住院时间，并在 VH 和 LAVH 组患者中进行比较分析。
共纳入 227 名女性（151 名患者行 VH，76 名患者行 LAVH，按照 2:1 的比例随机分组，以反映该单位之前的手术模式）。两组患者的年龄、产次和体重指数相匹配。两组患者的子宫重量平均值以及平均血清血红蛋白变化、术中及即刻术后并发症和康复期持续时间无显著差异。两种手术方式的手术时间和成本存在统计学差异。平均而言，LAVH 手术时间长于 VH（62.8±9.3 比 29.9±6.6 分钟，p<0.0001），成本也更高，主要是由于手术时间较长和所需耗材较多。与 VH 相比，行 LAVH 需要多 15698.20 南非兰特（ZAR）或 1145.85 美元（USD）。所有 VH 和 LAVH 均顺利完成，无严重并发症或中转开腹。
我们的数据表明，对于大多数患有良性病变和非脱垂子宫的女性，VH 是一种可行且安全的替代方法，其手术时间短、成本低。
