Johns D A, Diamond M P
Harris Methodist Hospital, Fort Worth, Texas.
J Reprod Med. 1994 Jun;39(6):424-8.
The list of gynecologic operations that can be performed by operative laparoscopy has expanded rapidly and now includes hysterectomy, yet there has been little critical assessment of the clinical outcome and complications of these procedures. This report is a retrospective review of 119 laparoscopically assisted vaginal hysterectomies (LAVHs). The most common indications were pelvic pain, menorrhagia, pelvic mass and uterine myomas. Of the 119 women, 94 (79%) had one or more factors considered to be absolute or relative contraindications to vaginal hysterectomy. The average operating time was 79 +/- 3 (SEM) minutes, with an estimated blood loss of 135 +/- 10 mL and an average length of hospitalization of 59 +/- 2 hours. Intraoperative complications were limited to vaginal entry into the bladder in one patient. Sixteen women had estimated blood losses > 300 mL; none received a blood transfusion. To more accurately describe the laparoscopic procedure performed, a staging system classifying the extent of the laparoscopic portion of the procedure is presented. Such a system is helpful for assessing the risk/benefit ratio of LAVH. While the findings of this study suggest the potential advantages of LAVH, future studies will be required to determine the specific efficacy of the procedure.
可通过手术腹腔镜进行的妇科手术清单迅速增加，目前已包括子宫切除术，但对这些手术的临床结果和并发症几乎没有严格评估。本报告是对119例腹腔镜辅助阴式子宫切除术（LAVH）的回顾性研究。最常见的适应证是盆腔疼痛、月经过多、盆腔肿块和子宫肌瘤。在这119名女性中，94名（79%）有一个或多个被认为是阴式子宫切除术绝对或相对禁忌证的因素。平均手术时间为79±3（标准误）分钟，估计失血量为135±10毫升，平均住院时间为59±2小时。术中并发症仅限于1例患者阴道进入膀胱。16名女性估计失血量>300毫升；无人接受输血。为了更准确地描述所进行的腹腔镜手术，提出了一种对手术腹腔镜部分范围进行分类的分期系统。这样的系统有助于评估LAVH的风险/效益比。虽然本研究结果表明LAVH有潜在优势，但未来还需要研究来确定该手术的具体疗效。
