Daniell J F, Kurtz B R, McTavish G, Gurley L D, Shearer R A, Chambers J F, Staggs S M
Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, TN 37203.
J Reprod Med. 1993 Jul;38(7):537-42.
It is now possible to begin a difficult hysterectomy via laparoscopy with or without adnexal removal and then complete the operation vaginally. We report our successful experience with laparoscopically assisted vaginal hysterectomy in 62 of 68 patients. Techniques used for hemostatic separation of the uterus and adnexal pedicles included an automatic laparoscopic stapling device (49 cases), bipolar coagulation with sharp transection (11) and combined techniques (2). Minor complications occurred in four patients. Six patients had their operations converted from laparoscopy to laparotomy because of significant adhesions (three), large fibroids (two) and poor access due to obesity (one). The use of a stapling device required less anesthesia time (1 hour, 57 minutes, vs. 3 hours, 43 minutes), a smaller blood loss (145 vs. 247 mL) and shorter hospital stays (2.53 vs. 2.75 days) than did laparoscopic bipolar coagulation. However, the average hospital costs were greater for disposable automatic stapling devices and trocars when compared to bipolar coagulation techniques ($9,310 vs. $6,227). Postoperative patient satisfaction with the operation was high (98%), with a high rate of symptom resolution (95%). Laparoscopically assisted vaginal hysterectomy is a safe, effective operation in selected cases and may soon become a common alternative to abdominal hysterectomy in certain cases.
现在可以通过腹腔镜开始进行困难的子宫切除术，可切除或不切除附件，然后经阴道完成手术。我们报告了68例患者中62例腹腔镜辅助阴式子宫切除术的成功经验。用于子宫和附件蒂止血分离的技术包括自动腹腔镜吻合器（49例）、双极电凝锐性横断（11例）和联合技术（2例）。4例患者出现轻微并发症。6例患者因粘连严重（3例）、肌瘤较大（2例）和肥胖导致手术入路不佳（1例），手术由腹腔镜转为开腹。与腹腔镜双极电凝相比，使用吻合器所需麻醉时间更少（1小时57分钟对3小时43分钟）、失血量更少（145对247毫升）、住院时间更短（2.53对2.75天）。然而，与双极电凝技术相比，一次性自动吻合器和套管针的平均住院费用更高（9310美元对6227美元）。术后患者对手术的满意度较高（98%），症状缓解率较高（95%）。腹腔镜辅助阴式子宫切除术在特定病例中是一种安全、有效的手术，在某些情况下可能很快成为腹式子宫切除术的常见替代方法。
