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골반경에 의한 질식 전자궁적출술의 임상적 고찰

Clinical Survey of Total Vaginal Hysterectomy by Pelviscopy

대한산부인과학회지 1993년 36권 4호 p.497 ~ 502
김중환
이재창/문종수/김홍배/허민

Abstract


From January, 1991, to October 1992, 202 pelviscopically assisted vaginal hysterectomy (PAVH) were performed at Department Obstetrics and Gynecology, College of Medicine, Chung-Ang University. The PAVH indications based on the preoperative
diagnosis
were myoma uteri, adenomyosis with severe dysmenorrhea, chronic PID or pelvic pain, dysfunctional uterine bleeding, cervical intraepithelial neoplasia, etc. Some of patients also underwent concomittant procedures including incidental
appendectomy,
posterior wall repair, pelvic adhesiolysis, salpingo-oophorectomy, etc, Bipolar forceps were used to compress and desiccate vessels. The Nd-YAG LASER, scissors, and/or unipolar electrode were used for tissue division, excision of adhesions, and
cutting.
The intraoperative complications were bladder perforation and massive hemorrhage. The postoperative complications were voiding difficulty, febrile morbidity, partial small bowel obstruction, incisional hernia and peroneal nerve plasy.
The mean operating time was 110 minutes and the mean estimated blood loss was 1.2 gm/dl hemoglobin. The mean hospital days were 5.2 days and the mean age of the patients was 41 years old.
The advantages of vaginal surgery are reduced postoperative morbidity, avoidance of an abdominal scar and shorter hospital day. However, the PAVH allows for optimal exploration of the pelvic cavity and adnexa.
This study demonstrates that the PAVH can be safely performed pelviscopically by the well trained pelviscopists, resulting in reduced surgical morbidity, blood loss, postoperative discomfort and pain, shortened hospital stay land recovery.
This pelviscopic procedure provided us to determine whether to do the vaginal hysterecotomy, and furthermore, made it possible to change most of the abdominal hysterectomies to PAVH.

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