Chapron C, Dubuisson J B, Ansquer Y
Service de Chirurgie Gynecologique, Clinique Universitaire Baudelocque, C.H.U. Cochin Port-Royal, Paris, France.
Hum Reprod. 1996 Oct;11(10):2122-6. doi: 10.1093/oxfordjournals.humrep.a019060.
The great majority of hysterectomies in nulliparous patients have been carried out via laparotomy. The purpose of this study was to establish whether laparoscopic surgery can be of use in an attempt to reduce the number of laparotomies when hysterectomy is indicated in patients without previous vaginal delivery. A retrospective study was carried out on 66 women who had not had a previous vaginal delivery who underwent hysterectomy from January 1993 to May 1995. Laparotomy was required for only 19.7% of cases (13 patients). For the 53 patients (80.3%) who underwent laparoscopic hysterectomy, the average duration of the operation was 152.24 +/- 45.7 min, and the average weight of the uterus was 238.3 +/- 154.1 g. The duration of the laparoscopic operation was correlated in a statistically significant fashion with the weight of the uterus (P = 0.0005), the necessity of associated procedures during the hysterectomy (P = 0.01) and the surgeons' experience (P = 0.01). These results demonstrated that laparoscopic surgery decreases the number of laparotomies necessary for patients with no previous vaginal delivery who require hysterectomy. When vaginal access is poor, simple laparoscopic preparation is inadequate and the only possibility of avoiding laparotomy is to carry out the hysterectomy entirely via the laparoscopic route.
未产妇行子宫切除术大多通过剖腹手术进行。本研究的目的是确定在未经历过阴道分娩的患者有子宫切除指征时，腹腔镜手术是否有助于减少剖腹手术的数量。对1993年1月至1995年5月期间66例未经历过阴道分娩且接受子宫切除术的妇女进行了一项回顾性研究。仅19.7%的病例（13例患者）需要剖腹手术。对于53例（80.3%）接受腹腔镜子宫切除术的患者，手术平均时长为152.24±45.7分钟，子宫平均重量为238.3±154.1克。腹腔镜手术时长与子宫重量（P = 0.0005）、子宫切除术中进行相关操作的必要性（P = 0.01）以及外科医生的经验（P = 0.01）在统计学上显著相关。这些结果表明，腹腔镜手术减少了未经历过阴道分娩且需要子宫切除的患者所需的剖腹手术数量。当阴道入路不佳时，单纯的腹腔镜准备并不充分，避免剖腹手术的唯一可能是完全通过腹腔镜途径进行子宫切除术。
