Morbidity of 10,110 hysterectomies by type of approach
Morbidity of 10,110 hysterectomies by type of approach
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DOI：
10.1093/humrep/16.7.1473
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发表时间：
2001-07-01
影响因子：
6.1
通讯作者：
Sjöberg, J
中科院分区：
文献类型：
--
作者：
Mäkinen, J;Johansson, J;Sjöberg, J
背景技术背景：自20世纪80年代后期以来，腹腔镜子宫切除术的选择引起了关于子宫切除术最合适方法的问题，方法：为了评价方法类型的影响，在引起或避免尿道切除术中的某些投诉方面，进行了一项前瞻性的全国性研究，包括1996年在芬兰进行的所有良性疾病的尿道切除术，关注的主要结局是手术相关发病率、常见手术细节和术后并发症。研究结果：10110例直肠癌切除术中，经腹手术5875例，阴式手术1801例，腹腔镜手术2434例，总并发症发生率较低，分别为17.2%、23.3%和19.0%，其中感染是最常见的并发症，经腹手术、阴式手术和腹腔镜手术的发生率分别为10.5%、13.0%和9.0%。腹部、阴道和腹腔镜组中最严重类型的出血事件发生率分别为2.1%、3.1%和2.7%。输尿管损伤在腹腔镜组中占主导地位[与腹部相比的相对风险（RR）7.2]，而肠损伤在阴道组中最常见（与腹部相比的RR 2.5）。进行过30次以上腹腔镜输尿管切除术的外科医生输尿管和膀胱损伤的发生率（分别为0.5%和0.8%）显著低于进行过少于或等于30次手术的外科医生（分别为2.2%和2.0%）。随着阴道直肠切除术经验的增加，肠道并发症也呈下降趋势。结论：这项关于直肠癌切除术的大规模观察性研究提供了腹部、阴道或腹腔镜手术相关发病率的新信息。结果支持了外科医生经验在减少严重并发症方面的重要性，特别是在腹腔镜和阴道子宫切除术中。
BACKGROUND: Since the late 1980s, the option of laparoscopic hysterectomy has raised questions about the most suitable approach to hysterectomy, METHODS: To evaluate the influence of the type of approach, in causing or avoiding certain complaints in hysterectomies a prospective nationwide study was conducted comprising all hysterectomies for benign disease performed in Finland during 1996, The primary outcomes of interest were the operation-related morbidity, common surgical details and post-operative complications. RESULTS: A total of 10 110 hysterectomies, including 5875 abdominal, 1801 vaginal and 2434 laparoscopic operations showed a low rate of overall complications, 17.2, 23.3 and 19.0% respectively, Infections were the most common complications with incidences of 10.5, 13.0 and 9.0% in the abdominal, vaginal and laparoscopic group respectively, The most severe type of haemorrhagic events occurred in 2.1, 3.1 and 2.7% in the abdominal, vaginal and laparoscopic group respectively. Ureter injuries were predominant in laparoscopic group [relative risk (RR) 7.2 compared with abdominal] whereas bowel injuries were most common in vaginal group (RR 2.5 compared with abdominal). Surgeons who had performed > 30 laparoscopic hysterectomies had a significantly lower incidence of ureter and bladder injuries (0.5 and 0.8% respectively) than those who had performed less than or equal to 30 operations (2.2 and 2.0% respectively). A decreasing trend of bowel complications was also seen with increasing experience in vaginal hysterectomies. CONCLUSIONS: This large-scale observational study on hysterectomies provides novel information on operation-related morbidity of abdominal, vaginal or laparoscopic approach. The results support the importance of the experience of the surgeon in reducing severe complications, especially in laparoscopic and vaginal hysterectomies.