Härkki-Siren P, Sjöberg J
Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Finland.
Acta Obstet Gynecol Scand. 1995 Sep;74(8):638-41. doi: 10.3109/00016349509013478.
We analyzed the first one hundred laparoscopic hysterectomies done by one senior gynecologist to study the learning curve and complications of this technique.
One hundred laparoscopic hysterectomies done for uterine fibroid (64%), menorrhagia (20%), adenomyosis or endometriosis (10%), cervical dysplasia (3%) and endometrial cancer (3%) were studied.
No conversion to laparotomy was needed. The weight of the uterus ranged from 70 to 470 grams (mean 206 g) and the operating time ranged from 45 to 245 minutes (mean 109 min). The mean operating time was reduced from 180 to 75 minutes. The uterine weight and the weight of the patient had a positive correlation to operating time. The use of automatic staplers or clips did not reduce the operating time. Ten complications occurred: one perforation of the urinary bladder, five bleedings and four pelvic infections.
The operating time was clearly shortened during the first one hundred laparoscopic hysterectomies. The rate of the complications did not fall similarly. Technical complications (bladder perforation and intraoperative bleeding) occurred in the beginning. Complications like infection and bleeding do not seem to disappear with experience. Laparoscopic hysterectomy appears to be as safe as abdominal or vaginal hysterectomy and the postoperative convalescence time is short. It is clearly an acceptable alternative to hysterectomy.
我们分析了一位资深妇科医生所做的前100例腹腔镜子宫切除术，以研究该技术的学习曲线和并发症。
对因子宫肌瘤（64%）、月经过多（20%）、子宫腺肌病或子宫内膜异位症（10%）、宫颈发育异常（3%）和子宫内膜癌（3%）而行的100例腹腔镜子宫切除术进行了研究。
无需转为开腹手术。子宫重量在70至470克之间（平均206克），手术时间在45至245分钟之间（平均109分钟）。平均手术时间从180分钟减少至75分钟。子宫重量和患者体重与手术时间呈正相关。使用自动吻合器或夹子并未缩短手术时间。发生了10例并发症：1例膀胱穿孔、5例出血和4例盆腔感染。
在前100例腹腔镜子宫切除术中，手术时间明显缩短。并发症发生率并未同样下降。技术并发症（膀胱穿孔和术中出血）在开始时出现。感染和出血等并发症似乎不会随着经验的增加而消失。腹腔镜子宫切除术似乎与腹式或阴式子宫切除术一样安全，术后恢复时间短。显然是子宫切除术的一种可接受的替代方法。
