A Clinical Study on 570 Cases of Laparoscopy Assisted Vaginal Hysterectomy (LAVH)

복강경하 질식 전자궁적출술 (LAVH) 570예에 대한 임상적 고찰

Choi, Jang-Yeul;Song, Jung-In;Chul, Whang-Byung;Lee, Soon-Pyo;Choi, Yu-Duk;Park, Chan-Yong;Yoon, Seong-Jun
최장열;송정인;황병철;이순표;최유덕;박찬용;윤성준

  • Published : 20041000

Abstract

Objective : To evaluate the clinical outcome and characteristics of laparoscopy assisted vaginal hysterectomy (LAVH) in gynecologic patients. Methods : From September, 2001 to February, 2004, total 570 cases of patients were performed LAVH at Gacheon medical school Ghil Hospital. We reviewed medical records and analyzed these cases about age, parity, weight, previous surgery history, operation indication, operation outcome, duration of hospitalization and complication. Results : The results of this study summarized as follows. The mean age of patients was 46.4${\pm}$7.2 years old. Average parity of patients was 2.4${\pm}$1.4. Average weight of patients was 63.4${\pm}$8.2 kg. Previous operation history was 195 cases (34.2%). Most common operation indication was uterine leiomyoma, followed by adenomyosis, combination of leiomyoma and adenomyosis and endometriosis. The mean operation time was 72${\pm}$20.6 minutes. The mean duration of hospitalization was 4.5${\pm}$0.6 days. The major complication of operation was trocar site bleeding, followed by bladder injury, bowel injury, and ureteral injury. Conclusion : LAVH is safe and useful. So it is recommendable to gynecologic patients.

목적 : 복강경하 질식 전자궁적출술을 시행받은 부인과 환자에 있어서 환자들의 특징과 임상 결과를 보고하여 그 효율성을 평가하기 위하여 후향성 연구를 시행하였다. 연구 방법 : 2001년 9월부터 2004년 2월까지 가천의과대학교 길병원 산부인과에서 골반경하 질식 전자궁적출술을 시행받은 570명의 환자를 대상으로 하였다. 평균 나이, 출산력, 체중, 이전 수술 기왕력, 수술 적응증, 수술 결과, 그리고 수술 합병증 등을 비교하였다. 결과 : 평균 나이는 46.4${\pm}$7.2세였다. 평균 출산력은 2.4${\pm}$1.4회였으며 평균 체중은 63.4${\pm}$8.2 kg였다. 이전 수술 기왕력은 총 195회 (34.2%)였다. 수술의 적응증은 자궁근종 및 자궁선종이 총 75.1%로 가장 많았다. 평균수술 시간은 72.3${\pm}$20.6분이었으며 평균 재원일은 4.5${\pm}$0.6일이었다. 주된 합병증은 투관침 부위 출혈, 방광 손상, 장손상, 요도 손상 등이었다. 결론 : 복강경하 질식 전자궁적출술은 안전하고 효율적인 수술술기로서 기존의 개복수술을 대체하여 부인과 질환에 더욱 폭넓게 사용할 수 있겠다.

Keywords

References

  1. Jacobeus HC. Uber die Moglichakeit die Zystoskopie bei Undersuchung seroser Hohlungen anzuwenden. Munch Med Wochenschr 1910; 57: 2090
  2. Shapiro HI, Alder DH. Excision of an ectopic pregnancy through the laparoscope. Am J Obstet Gynecol 1973; 117: 290-1
  3. Reich H, DeCaprio J, McGlynn F. Laparoscopic hysterectomy. J Gynecol Surg 1989; 5: 213-6 https://doi.org/10.1089/gyn.1989.5.213
  4. Musich JR, Behrman SJ. Infertility laparoscopy in perspective review of five hundred cases. Am J Obstet Gynecol 1982; 143: 293
  5. Querleu D, Leblanc E, Castclain B. Laparoscopic pelvic lymphadenectomy in the staging of early carcinoma of cervix. Am J Obstet Gynecol 1991; 164: 579-81 https://doi.org/10.1016/S0002-9378(11)80025-6
  6. Lee CL, Soong YK. Laparoscopic hysterectomy with the endoGIA 30 staples. J Reprod Med 1993; 38: 424-8
  7. National Center for Health Statistics. Health, United states; 1998 with Socioeconomic Status and Health Chartbook. Hyattsville: U.S. Department of Health and Human Services; 1998: 311-3
  8. Farquhar CM, Steiner CA. Hysterectomy rates in the United States 1990- 1997. Obstet Gynecol 2002; 99: 229-34 https://doi.org/10.1016/S0029-7844(01)01723-9
  9. American College of Obstetetricians and Gynecologists. Quality assurance in obstetrics and gynecology. Washington, DC: American College of Obstetrics and Gynecologists, 1989
  10. ACOG criteria set. Laparoscopically assisted vaginal hysterectomy. Int J Gynecol Obstet. 1996; 53: 91-2
  11. Summit, Robert L. Jr. Laparoscopic-assisted vaginal hysterectomy: A review of usefulness and outcomes. Clin Obstet Gynecol 2000; 43: 584-93
  12. Nwosu CR, Gupta JK. Abdominal, laparoscopic, and vaginal hysterectomy with bilateral salpingo-oophorectomy: A feasibility study for further evaluation in randomized trials. Surg Encosc. 1999; 13: 148-50 https://doi.org/10.1007/s004649900926
  13. Semm K. CISH (pelvicoscopic intrafascial hysterectomy-withoutcolpotomy), TUMA(total uterine mucosa ablation) and IVH(infrafascial vaginal hysterectomy). Gynacologe 1993; 26: 378-84
  14. Mornson JE, Jacobs VR. 437 classic intrafascial supracervical hysterectomies in 8 years. J Am Assoc Gynecol Laparosc 2001; 8: 558-67 https://doi.org/10.1016/S1074-3804(05)60621-4
  15. Reich H, McGlynn F, Sekel L. Total laparoscopic hysterectomy. Gynecol Endosc 1993; 2: 59-63
  16. Semm K. New methods of pelviscopy. Endoscopy 1979; 11: 85
  17. Lyons TL. Laparoscopic supracervical hysterectomy: A comparison of morbidity and mortality results with laparoscopically assisted vaginal hysterectomy. J Reprod Med 1993; 38: 763-7
  18. Pelosi MA, Pelosi MA III. Laparoscopic supracervical hysterectomy using a single-umbilical puncture(mini-laparoscopy). J Reprod Med 1992; 37: 777-84
  19. Garry R, Reich H, Liu CY. Laparoscopic hysterectomy-definitions and indications. Gynecol Endosco 1994; 3: 1(editorial)
  20. 이성환, 박철훈, 김용욱, 백승엽, 노덕영, 김태응 외 7인. 골반경하 질식 전자궁적출술의 임상적 고찰. 대한산부회지 2003; 46: 312-6
  21. 최용욱, 진건. 골반경하 질식 전자궁적출술(LAVH)과 복식 전자궁적출술(TAH)의 비교 연구. 대한산부회지 2002; 45: 24-31