在腹腔镜子宫切除术子宫分碎术并发症发生率 - 一项回顾性队列研究

在腹腔镜子宫切除术子宫分碎术并发症发生率 - 一项回顾性队列研究
Complication rate of uterine morcellation in laparoscopic supracervical hysterectomy- a retrospective cohort study

Abstract
摘要
BACKGROUND:
背景：
Over the last decades minimally invasive surgical techniques are increasingly used to treat symptomatic leiomyomas, providing the patient decreased morbidity and more rapid return to daily activities. Morcellation is the fragmentation of a large mass into smaller pieces to make resection through port incisions possible. Over the last year there has been a discussion worldwide about the safety of morcellation.
在过去的几十年里，微创外科技术越来越多的用于治疗有症状的子宫肌瘤，为患者降低发病率和更快速的恢复日常活动。分离是将一个大质量的分成更小的部分，通过端口切口可能切除的碎片。在过去的一年出现了关于分碎的全球安全的讨论。

OBJECTIVE:
目的：
The aim of our study was to identify the complication rate of power morcellation at our institution.
我们研究的目的是确定在我们的机构的权力分碎术的并发症发生率。

STUDY DESIGN:
研究设计：
We performed a retrospective chart analysis of patients undergoing laparoscopic supracervical hysterectomy with morcellation. We compared the outcomes of patients undergoing laparoscopic supracervical hysterectomy with the use of power morcellation with a control group of women who underwent laparoscopic-assisted vaginal hysterectomy without morcellation. Women who underwent hysterectomy because of suspected malignancy were excluded.
我们进行了腹腔镜子宫次全切除术的患者与分割的回顾性图表分析。我们比较了腹腔镜子宫次全切除术利用动力分割患者的结果，一个妇女接受腹腔镜辅助阴式子宫切除术的对照组没有分割。因为怀疑有恶性肿瘤的妇女接受子宫切除术的妇女被排除在外。

RESULTS:
结果:
A total of 358 patients underwent laparoscopic hysterectomy between 2004 and 2013; 186 laparoscopic supracervical hysterectomies and 172 laparoscopic-assisted vaginal hysterectomies. The main indication for laparoscopic supracervical hysterectomy was heavy menstrual bleeding and pelvic pressure or pain (94.5%). Baseline characteristics were not significantly different except for body mass index, with a mean of 25.7 in laparoscopic supracervical hysterectomy and 27.0 in laparoscopic-assisted vaginal hysterectomy. There was a significant greater uterine weight in the laparoscopic supracervical hysterectomy group (260g vs. 202g). The overall conversion rate was 5.3% (n=19), with no significant difference between the two groups and 79% of conversions being performed for strategic reasons. There was no statistical difference in intra-operative complication rate (2.1% vs. 1.2%). Pathology reports showed no unexpected malignancies. There was no statistical difference in the complication rate post-operatively (2.2% vs. 2.9%). The overall complication rate of laparoscopic supracervical hysterectomy was 4.3% (n=8). Need for reoperation after laparoscopic supracervical hysterectomy was necessary in 7 patients (3.8%), with cervical amputation being the most common type of reoperation (n=5). In the laparoscopic-assisted vaginal hysterectomy group there were significantly more adhesiolysis performed (n=4). Parasitic myomas were discovered in 1 patient two years after morcellation (0.5%).
共有358例患者行腹腔镜下全子宫切除术在2004年和2013年之间；186例腹腔镜下子宫切除及腹腔镜辅助阴式子宫切除术172例。腹腔镜子宫切除术的主要适应症是月经出血和骨盆压痛（94.5%）。基线特征无显著差异外，身体质量指数，在腹腔镜子宫次全切除术平均25.7和27在腹腔镜辅助阴式子宫切除术。有一个显著更大重量的子宫在腹腔镜子宫次全切除术组（260g vs. 202g）。整体转换率为5.3%（n = 19），两组间差异无统计学意义和79%的转换正在执行的至关重要的原因。术中并发症发生率无统计学差异（2.1%比1.2%）。病理报告显示，没有意外的恶性肿瘤。术后并发症发生率无统计学差异（2.2%比2.9%）。腹腔镜下子宫次全切除术并发症总发生率为4.3%（n = 8）。需要再次手术后腹腔镜子宫次全切除术7例患者是必要的（3.8%），宫颈切断术是最常见的再手术类型（N = 5）。在腹腔镜辅助阴式子宫切除术组有更明显的粘连发生（n = 4）。分碎术两年后发现的寄生肌瘤1例（0.5%）。

CONCLUSION:
结论：
Our study showed no injuries directly related to morcellation. There were no unexpected malignancies morcellated and only one case of parasitic myomas (0.5%).
我们的研究显示无损伤分离直接相关。没有意外的相关恶性肿瘤且只有一个寄生肌瘤（0.5%）。

原文：
Complication rate of uterine morcellation in laparoscopic supracervical hysterec.pdf (258.71 KB, 下载次数: 0, 售价: 99 香叶)

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