Mazdisnian F, Kurzel R B, Coe S, Bosuk M, Montz F
Department of Obstetrics and Gynecology, Olive View-University of California Los Angeles Medical Center, Sylmar, USA.
Obstet Gynecol. 1995 Jul;86(1):60-4. doi: 10.1016/0029-7844(95)00086-7.
To evaluate the relationship between uterine size and a possible increase in operative morbidity and procedure failure rates in women undergoing total vaginal hysterectomy.
A retrospective chart analysis of all hysterectomies performed for histologically confirmed leiomyomata was completed. A total of 128 cases qualified. Patients were stratified into three groups: group I, patients undergoing vaginal hysterectomy with a uterine weight of 300 g or greater but less than 1000 g; group II, patients undergoing vaginal hysterectomy with a uterine weight of 100-299 g; and group III, patients undergoing abdominal hysterectomy with a uterine weight of 100-1000 g. The variables evaluated included the following: length of hospital stay, operative time, estimated blood loss, and operative complications. Data regarding failed vaginal hysterectomy requiring an abdominal approach were also obtained.
Both vaginal hysterectomy groups had a significantly reduced length of stay compared with the total abdominal hysterectomy group. There was no significant difference in mean estimated blood loss between groups I and III. Similarly, there were no significant differences in complication rates among the three groups. Group I had an 84% (31 of 37) success rate versus 95% (40 of 42) for group II (not statistically significant). There were no significant differences in the mean uterine weight, estimated blood loss, and complication rate in unsuccessful versus successful vaginal hysterectomies. The estimated blood loss was significantly higher for unsuccessful vaginal hysterectomy.
Uterine size alone is not an absolute contra-indication to vaginal hysterectomy. Large uterine size (greater than 300 g) was not related to a significant increase in failed vaginal hysterectomy. Conversely, failed vaginal hysterectomy was not size-dependent. Furthermore, there is no additional operative morbidity when vaginal hysterectomy is converted to a total abdominal hysterectomy because of a technical inability to complete the surgery vaginally.
评估全阴道子宫切除术患者子宫大小与手术发病率可能增加及手术失败率之间的关系。
对所有因组织学确诊为平滑肌瘤而进行子宫切除术的病例进行回顾性图表分析。共有128例符合条件。患者被分为三组：第一组，子宫重量为300克或以上但小于1000克的接受阴道子宫切除术的患者；第二组，子宫重量为100 - 299克的接受阴道子宫切除术的患者；第三组，子宫重量为100 - 1000克的接受腹式子宫切除术的患者。评估的变量包括：住院时间、手术时间、估计失血量和手术并发症。还获得了因阴道子宫切除术失败而需要改为腹式手术的数据。
与全腹式子宫切除术组相比，两个阴道子宫切除术组的住院时间均显著缩短。第一组和第三组之间的平均估计失血量没有显著差异。同样，三组之间的并发症发生率没有显著差异。第一组的成功率为84%（37例中的31例），而第二组为95%（42例中的40例）（无统计学意义）。不成功与成功的阴道子宫切除术在平均子宫重量、估计失血量和并发症发生率方面没有显著差异。不成功的阴道子宫切除术的估计失血量显著更高。
仅子宫大小并非阴道子宫切除术的绝对禁忌证。子宫较大（大于300克）与阴道子宫切除术失败率的显著增加无关。相反，阴道子宫切除术失败与子宫大小无关。此外，由于技术上无法经阴道完成手术而将阴道子宫切除术改为全腹式子宫切除术时，不会增加额外的手术发病率。
