Morbidity of 10,110 hysterectomies by type of approach

被引:270
作者
Mäkinen, J [1 ]
Johansson, J
Tomás, C
Tomás, E
Heinonen, PK
Laatikainen, T
Kauko, M
Heikkinen, AM
Sjöberg, J
机构
[1] Turku Univ Hosp, Dept Obstet & Gynecol, FIN-20520 Turku, Finland
[2] Helsinki Univ Hosp, Dept Obstet & Gynecol, FIN-00290 Helsinki, Finland
[3] Kuopio Univ Hosp, Dept Obstet & Gynecol, FIN-70211 Kuopio, Finland
[4] N Carelia Cent Hosp, Dept Obstet & Gynecol, Joensuu 80210, Finland
[5] Helsinki City Matern Hosp, Dept Obstet & Gynecol, Helsinki 00610, Finland
[6] Tampere Univ Hosp, Dept Obstet & Gynecol, FIN-33521 Tampere, Finland
[7] Oulu Univ Hosp, Dept Obstet & Gynecol, FIN-90221 Oulu, Finland
关键词
complication; epidemiology; gynaecology; hysterectomy; laparoscopy;
D O I
10.1093/humrep/16.7.1473
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
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.
引用
收藏
页码:1473 / 1478
页数:6
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