Daraï E, Bernard G, Filippini F, Fauconnier A, Bénifla J L, Meneux E, Benzakine Y, Panel P, Madelenat P
Service de Gynécologie, CHU Bichat-Claude-Bernard, Paris.
Ann Chir. 1998;52(1):29-35.
Our objective was to determine the limits of laparoscopic-assisted vaginal hysterectomy (LAVH) and the value of a preoperative scoring system to determine the operative approach to hysterectomy. Between January 1991 and December 1996, 152 out of 177 patients had LAVH and 25 had laparoconversion. The mean operating time was 163 min. The overall postoperative complication rate was 8.4%. The hospital stay was 4.8 days for LAVH versus 6.2 days for laparoconversion (p < 0.01). For each patient, a preoperative scoring system was established according to uterine size, previous laparotomy, uterine mobility, pelvic adhesions and endometriosis stage. The laparoconversion rate increased according to the score, as it was 7.8% for a score < or = 7 and 80% for a score > 7. LAVH offers a technique to convert some abdominal hysterectomies into vaginal hysterectomies. The use of the preoperative scoring system may help to determine patients who may benefit from the laparoscopic route and those with a high risk of laparoconversion.
我们的目的是确定腹腔镜辅助阴式子宫切除术（LAVH）的限度以及术前评分系统对于确定子宫切除术手术方式的价值。1991年1月至1996年12月期间，177例患者中有152例行LAVH，25例行剖腹手术改道。平均手术时间为163分钟。术后总体并发症发生率为8.4%。LAVH患者的住院时间为4.8天，而剖腹手术改道患者为6.2天（p<0.01）。对于每例患者，根据子宫大小、既往剖腹手术史、子宫活动度、盆腔粘连和子宫内膜异位症分期建立术前评分系统。剖腹手术改道率随评分增加而升高，评分≤7分时为7.8%，评分>7分时为80%。LAVH提供了一种将某些腹部子宫切除术转变为阴式子宫切除术的技术。术前评分系统的应用可能有助于确定哪些患者可能从腹腔镜手术途径中获益，以及哪些患者有较高的剖腹手术改道风险。
