Weber A M, Lee J C
Department of Gynecology and Obstetrics, Cleveland Clinic Foundation, OH 44195, USA.
N Engl J Med. 1996 Aug 15;335(7):483-9. doi: 10.1056/NEJM199608153350706.
Laparoscopically assisted vaginal hysterectomy has been promoted as a substitute for both abdominal and vaginal hysterectomy, with claimed benefits of lower costs, shorter hospital stays, and quicker postoperative recovery.
Using computerized hospital-discharge data for 1988-1994 from 180 hospitals in Ohio, we analyzed rates of abdominal, vaginal, and laparoscopically assisted vaginal hysterectomy and their association with characteristics of patients, complications, in-hospital mortality, and hospital charges.
The annual age-adjusted rate of hysterectomy fell 10 percent, from 4.53 per 1000 female state residents in 1988 to 4.07 per 1000 in 1994 (P<0.001). In 1988, 1.1. percent of all hysterectomies were performed by the laparoscopically assisted vaginal technique; this proportion increased to 9.2 percent in 1993 and declined to 7.5 percent in 1994. For gynecologic conditions other than cancer or pregnancy, women undergoing laparoscopically assisted vaginal hysterectomy as compared with one of the other techniques were more likely to have commercial insurance and to have their surgery at an urban hospital for diagnoses related to pain, endometriosis, or pelvic inflammatory disease. With abdominal and laparoscopically assisted vaginal hysterectomy, the complication rates were similar and were higher than those with vaginal hysterectomy. In-hospital mortality was similar for vaginal and laparoscopically assisted vaginal hysterectomy and was lower than for abdominal hysterectomy. Median hospital charges were $8,108 for laparoscopically assisted vaginal hysterectomy, $5,723 for abdominal hysterectomy, and $5,049 for vaginal hysterectomy.
The rate of hysterectomy in Ohio decreased from 1988 to 1994, as laparoscopically assisted vaginal hysterectomy became more common. Laparoscopically assisted vaginal hysterectomy was associated with higher hospital charges than the other techniques.
腹腔镜辅助阴式子宫切除术已被推广为腹式子宫切除术和阴式子宫切除术的替代方法，据称具有成本更低、住院时间更短和术后恢复更快的优点。
利用俄亥俄州180家医院1988 - 1994年的计算机化出院数据，我们分析了腹式、阴式和腹腔镜辅助阴式子宫切除术的发生率及其与患者特征、并发症、院内死亡率和住院费用的关系。
子宫切除术的年龄调整年发生率下降了10%，从1988年每1000名该州女性居民中的4.53例降至1994年的每1000名中的4.07例（P<0.001）。1988年，所有子宫切除术中1.1%采用腹腔镜辅助阴式技术；这一比例在1993年增至9.2%，1994年降至7.5%。对于癌症或妊娠以外的妇科疾病，与其他技术之一相比，接受腹腔镜辅助阴式子宫切除术的女性更有可能拥有商业保险，并且更有可能在城市医院因与疼痛、子宫内膜异位症或盆腔炎相关的诊断而接受手术。腹式和腹腔镜辅助阴式子宫切除术的并发症发生率相似，且高于阴式子宫切除术。阴式和腹腔镜辅助阴式子宫切除术的院内死亡率相似，且低于腹式子宫切除术。腹腔镜辅助阴式子宫切除术的住院费用中位数为8108美元，腹式子宫切除术为5723美元，阴式子宫切除术为5049美元。
随着腹腔镜辅助阴式子宫切除术变得更加普遍，俄亥俄州的子宫切除术发生率从1988年到1994年有所下降。腹腔镜辅助阴式子宫切除术与比其他技术更高的住院费用相关。
