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首页> 外文期刊>Gynecological Surgery >Primary intent vaginal hysterectomy: outcomes for common contraindications to vaginal approach hysterectomy
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Primary intent vaginal hysterectomy: outcomes for common contraindications to vaginal approach hysterectomy

机译：原发性意图性阴道子宫切除术：阴道入路子宫切除术的常见禁忌症的结果

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The objective of this study is, within a broadly inclusive selection strategy for benign vaginal hysterectomy, to determine whether the most commonly invoked “contraindications” to vaginal hysterectomy—fibroid enlargement 14 weeks, prior cesarean, need for oophorectomy—result in increased risk of complications. This study is of retrospective design within a rural community hospital. All vaginal hysterectomies performed by a single practitioner over an 11-year-period (1998–2009) were used as samples in this study. With few exclusions, all candidates for benign hysterectomy underwent vaginal hysterectomy. Comparison was made between vaginal cases without enlargement 14 weeks, prior cesarean, or need for oopherectomy defined as “Standard” and those with contraindications defined as “Non-standard.” Intraoperative complications and morbidity, including conversion to abdominal route, and postoperative morbidity, including return to the OR, transfusions, and length of hospital stay, were the main outcome measures. Of 325 hysterectomies attempted vaginally during the study period, 165 were classified as “Standard” and 160 classified as “Non-standard.” Hysterectomy was completed vaginally in 311 (95.7%) patients, while 14 (4.3%) required abdominal conversion; more common for the non-standard group (8.1% vs. 0.6%, p 0.05). Complications not requiring conversion were not different. Only operative time, EBL, and uterine weight were increased for the non-standard group (p 0.05). No differences were seen in length of stay, early, or late postoperative complications. Uterine enlargement 14 weeks, prior cesarean, or oophorectomy conventionally contraindicates vaginal hysterectomy; a primary intent vaginal hysterectomy strategy using broad inclusion criteria results in a high vaginal hysterectomy rate, and low complication rates no greater for vaginal hysterectomies performed with contraindications than for those performed without such contraindications.
机译：这项研究的目的是在广泛的良性阴道子宫切除术选择策略中，确定是否最常用的阴道子宫切除术“禁忌症”（即子宫肌瘤增大> 14周，剖腹产，需要进行卵巢切除术）是否会增加患上子宫切除术的风险。并发症。这项研究是在农村社区医院的回顾性设计。在此研究中，由一名执业医生在11年（1998-2009年）内进行的所有阴道子宫切除术均作为样本。除少数例外，所有良性子宫切除术的候选人均接受了阴道子宫切除术。比较没有肿块大于14周的阴道病例，既往剖宫产或需要进行卵巢切除术的阴道病例与定义为“非标准”禁忌症的阴道病例。术中并发症和发病率（包括转换为腹腔途径）和术后发病率（包括返回手术室，输血和住院时间）是主要的预后指标。在研究期间，在325例阴道镜检查过的子宫切除术中，有165例归类为“标准”，有160例归类为“非标准”。 311例（95.7％）的患者完成了阴道子宫切除术，而14例（4.3％）的患者需要进行腹部转换。非标准组更常见（8.1％vs. 0.6％，p <0.05）。不需要转换的并发症没有什么不同。非标准组仅手术时间，EBL和子宫重量增加（p <0.05）。住院时间，术后早期或晚期并发症无差异。子宫增大> 14周，先行剖宫产或行卵巢切除术通常禁忌阴道子宫切除术。使用广泛纳入标准的主要目的阴道子宫切除术策略会导致阴道子宫切除术的发生率高，并且并发症低的并发症发生率比没有禁忌症的阴道子宫切除术高。

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