Total laparoscopic hysterectomy for enlarged uteri: factors associated with the rate of conversion to open surgery
Total laparoscopic hysterectomy for enlarged uteri: factors associated with the rate of conversion to open surgery
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DOI：
10.1080/01443615.2019.1575342
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发表时间：
2019-04-16
影响因子：
1.3
通讯作者：
Uccella, S.
中科院分区：
文献类型：
--
作者：
Cianci, S.;Alletti, S. Gueli;Uccella, S.
由于暴露于手术空间的限制，因子宫增大而进行子宫切除术被认为是妇科外科医生面临的挑战。我们的目的是调查可能影响转为开放手术风险的不同变量。这是一项回顾性队列研究，包括133名因子宫肌瘤接受手术并通过腹腔镜途径尝试全子宫切除术的女性。子宫重量中位数为622 g（范围301-3882），较大肌瘤的最大直径中位数为74 mm（范围33-148）。我们登记了13例（9.8%）中转开腹手术。分别有4例（3%）和4例（3%）病例记录了轻微和严重术后并发症。多变量分析后，外科医生的经验（OR：0.24; 95%CI：0.06-0.94，p = 0.027）和最大肌瘤的最大直径>= 10 cm（4.7; 1.39-15.87; p = 0.046）与转为开放手术的风险相关，而子宫重量与转为开放手术的风险无关。
A hysterectomy for enlarged uteri is considered a challenge for gynaecologic surgeons, due to the limit of exposure to surgical spaces. Our objective is to investigate the different variables that may have an impact on the risk of conversion to open surgery. This is a retrospective cohort study consisting of 133 women who were submitted to surgery for uterine fibroids and who underwent total hysterectomy by laparoscopic approach attempt. The median uterus weight was 622 grams (range 301-3882) and the median maximum diameter of the bigger fibroid was 74 mm (range 33-148). We registered 13 (9.8%) cases of conversion to laparotomy. Minor and major post-operative complications were recorded in 4 (3%) and in 4 (3%) cases, respectively. After multivariable analysis, the surgeon's experience (OR: 0.24; 95% CI: 0.06-0.94, p = .027) and a maximum diameter of the biggest fibroid >= 10 cm (4.7; 1.39-15.87; p = .046), but not the uterus weight were associated with the risk of conversion to open surgery.