Comparative Study of Improved Transvaginal Hysterectomy and Other Hysterectomies
|School||Hebei Medical University|
|Course||Obstetrics and Gynaecology|
|Keywords||Non-prolapsed uterus improved transvaginal hysterectomy transabdominal hysterectomy totallaparoscopic hysterectomy|
Objective: To discuss the advantages and the clinical practical value ofthe improved transvaginal hysterectomy (TVH).Methods: We identified75women who underwent the improvedtransvaginal hysterectomy、transabdominal hysterectomy and totallaparos-copic hysterectomy for benign disease other than symptomatic prolapse of theuterus in our gynecology department from January2010to November2011.The75cases were divided into three groups:transvaginal hysterectomygroup、transabdominal hysterectomy group and totallaparoscopic hysterecto-my group. Each group consisted of25cases and was compared respectively atthe same period. All patients were married and had Production history, werediagnosed benign uterine disease and needed excision of uterus, without anyprolapse of uterus or vaginal anterior and posterior walls bulging.Patients’production histories were1~3times, having no fertility requirements.Patients’ general conditions，such as age, size of the uterus，were notstatistically significant. Uterine sizes were smaller than16weeks of gestation.Preoperative B-ultrasound and gynecological examination for uterine size,activity and attachments confirmed no lesions. All patients preoperativechecked cervical cytology conventionally,coagulation function routine, bloodand urine routine, liver and kidney function tests, Hepatitis B and other virusinfection tests.Patients whose endometrium was suspected malignant mustundergo diagnostic curettage. All patients were excluded medical and surgicalcomplications.Each group of patients,common clinical data, the average operation time,the volume of hemorrhage, time of temperature recovery, infection afteroperation,time of bowel function recovery, length of hospital stay(afteroperation), hospitalization costs and complications after operation in the short term were gathered by hand. The intraoperative hemorrhage was calculated bynegative pressure suction bottle and immersed gauze. Documented datasubsequently analyzed by statistical software.Results: The procedures were successfully performed in all patients, andno case of transvaginal hysterectomy group or totallaparoscopic hysterectomygroup turned to abdominal incision intraoperatively.1patient oftotallaparoscopic hysterectomy group had urinary pain after removal ofurinary catheter24hours postoperatively,while other patients could urinatesmoothly. In3groups, there was no case of serious complications, injury ofpelvic organs, vaginal stump bleeded or hematoma in the short time afteroperation.Within The optional visits in the course of1month after operation,75patients’vaginal stump wound healing were good without any vaginalstump granulation tissue hyperplasia, and47cases of vaginal stump stillvisible knot yarn. More than20cases of patients had more vaginal secretions,told them to washed with washing liquid. There were3patients had fever intransvaginal hysterectomy group after operation (according to measuringtemperature4times every day and2times reached or over38℃in24h~5dafter operation); transabdominal hysterectomy group had2patients who hadfever after operation and1case had incision infected (about1cm length ofincision bottom had swelling and the a small quantity diffusate);totallaparoscopic hysterectomy group had1case appeared urinary infection(presenting pain during urination, and urine routine manifesting elevatingwhite blood cell count),and2patients had fever after operation. Thedifference of the average operation time of3groups was significant (p<0.05).The average operation time of transabdominal hysterectomy group wasthe shortest, about60.40min; transvaginal hysterectomy group was75.08min,15mim more than transabdominal hysterectomy group; The operation time oftotallaparoscopic hysterectomy group was the longest, about119.80min,muchlonger than the other two groups. The volume of hemorrhage, time oftemperature recovery, time of bowel function recovery, length of hospital stayof the3groups, compared respectively, the differences were not significant (P>0.05). In terms of postoperative infection, according to the white bloodcells count of blood routine of48hours after operation, higher than the normalrange, we concluded that the infected patients were the most oftotallaparoscopic hysterectomy and the patients of transvaginal hysterectomygroup were the least, but the differences in the statistics were notsignificant(P>0.05).The average hospitalization cost of3groups was:transvaginal hysterectomy group10316.88yuan; transabdominalhysterectomy group10773.12yuan;totallaparoscopic hysterectomy group13665.84yuan,and the difference was significant (all P <0.05). In ourhospital,the surgery fees of the three surgical methods are: transvaginalhysterectomy1402.75yuan，transabdominal hysterectomy1063.50yuan，totallaparoscopic hysterectomy2255.00yuan.From this,we can got that theaverage hospitalization cost of transvaginal hysterectomy is the least andtransvaginal hysterectomy is the most economical surgical method.In addition, transvaginal hysterectomy group and transabdominalhysterectomy group can adopt general anesthesia、 continuous epiduralanesthesia and combined spinal-epidural anesthesia，while totallaparoscopichysterectomy group can only use general anesthesia. Due to the abdominalcavity filled with CO2during laparoscopic surgery, patients need to take inoxygen6-1hours after operation.Conclusion: The common hysterectomy are:transvaginal hysterectomy、transabdominal hysterectomy and totallaparoscopic hysterectomy. Comparedwith transabdominal hysterectomy and totallaparoscopic hysterectomy,improved transvaginal hysterectomy has the advantages such as performedthrough the female natural route, almost no interference to gastrointestine, ashorter amount of operation time, less volume of hemorrhage, slighter painafter operation, a shorter time of bowel function recovery, eating earlier, lowerpostoperative pyrexia incidence, less complications after operation andshorter length of hospital stay, no scar left on the abdominal wall, lesshospitalization costs. Now, it has been accepted by the patient as a minimalinvasion operation, and has been widely carried out in our hospital gynecology department. In terms of the three surgical methods ofhysterectomy, no one can completely replace the others because eachhysterectomy has its indications、advantages and disadvantages. we shouldtake comprehensive consideration according to multiple factors includingpatients’ condition,surgical technique and hospital facilities.