Objective To examine the length of hospital stay and expenses associated with hysterectomy in China and to compare the results with those from developed counties, so as to provide comparative information about hysterectomy in China. Methods Hospital discharge data on hysterectomies performed in Peking Union Medical College Hospital from 2002 to 2006 were retrieved. The cases were classified into 3 groups, namely abdominal, laparoscopic and vaginal hysterectomy. The length of hospital stay and expenses associated with hysterectomy were analyzed retrospectively. Results Records of 5975 women who underwent hysterectomies were analyzed, including 3295 cases (65.7%) of abdominal hysterectomy, 1543 (25.8%) cases of laparoscopic hysterectomy (25.8%) and 507 (8.5%) cases of vaginal hysterectomy. The median (mean) postoperative length of stay were 6 (6.4) days, 4 (4.8) days and 5 (5.6) days in the abdominal, laparoscopic and vaginal hysterectomy groups, respectively. These were approximately 2 days longer than those in developed countries. The median total expenses were 6109.0, 7296.3 and 5265.2 RMB in the abdominal, laparoscopic and vaginal hysterectomy groups, respectively. After adjustment for the differences in Gross National Income (GNI) per capita between China and developed countries, the expenses associated with hysterectomy in China were 8.7 and 1.8-4.9 times higher than those in UK and USA, respectively. Conclusion Compared with abdominal and vaginal hysterectomies, laparoscopic hysterectomy is associated with a shorter postoperative length of stay, but with higher hospital cost. Compared with developed countries, hysterectomy is actually more expensive and associated with a longer hospital stay in China.
Objective To compare and assess the effectiveness between total vaginal hysterectomy (TVH), Laproscopical hysterectomy (LH) and minilaporotomy hysterectomy (MiniLPT). Methods We searched CBM, CKNJ, MEDLINE, EMbase, Cochrane DSR, ACP Journal Club, DARE, CCTR, CMR, HTA, and NHSEED to screen randomized controlled trials (RCTs) comparing one surgical approach to another of extrafascial hysterectomy (between TVH, LH and miniLPT) which were done to those women with benign gynecological diseases. As to economy assessment, studies of cost-effective analysis were also included. Those observational studies reporting rare or important long-term outcome were also included. The quality of the included studies was evaluated by GRADE (Grades of Recommendation, Assessment, Development and Evaluation) system and principle of Cochrane Reviewer Handbook 4.2.3 RCT. Results Finally, we identified 12 trials including 10 RCTs, 1 retrospective cohort study and 1 respective cohort study. Cost-effective analy- sis showed when in indication of VH, TVH was more cost-effective than LH. When TVH was less but still accessible, metaanalysis showed TVH had significant advantages than the other two approaches in many sides. Compared with LH arm, operation time was shorter at a WMD 47.2 min and 95%CI 32.2 to 62.3 min, blood loss was less at a WMD 158.7 ml and 95%CI – 190.9 to – 126.4 ml, hospital stay was shorter at a WMD 23.9 h and 95%CI – 25.4 to – 13.9 h, and the first stool or to break wind was quicker at a WMD – 8.1 h and 95%CI – 10.8 to – 5.3 h in TVH arm. But on the other side, the incidence rates of bad wound healing (such as vaginal cuff infection, abdominal wall infection, wound dehiscence, etc.), of secondary infection (such as UTI, URI, unknown infection, etc.), and of febrility were less common in LH arm than those in TVH arm with no significant difference. Meanwhile, ratio of sexual hypofunction, declined marital life quality and worse body image were more in TVH arm than those in LH arm, implying LH arm provided a better post-operation sexual life recovery. Operation time was longest in miniLPT arm at a WMD 37.0 h and 95%CI 13.5 to 60.5 h and blood loss was most at a WMD 208.5 ml and 95%CI 141.4 to 375.7 ml, too. The febrility rate was also the most common in miniLPT arm at a Peto OR 3.8 and 95% CI 1.1 to 12.6. The differences were significant. Conclusion TVH is the least invasive approach and better in cost-effectiveness when accessible. However, when inaccessible, the limitations remain unclear, depending on surgeons’ own techniques and experience as well as patients’ individual conditions. LH does better in improving quality of life and body image. Cost-effectiveness of LH may become much better by reducing blood loss during operation through improving techniques or instruments of hemostasis. Limited application of non-reproducible instrument or cost and promotion of their recycle may help a lot in bringing down LH operation cost, too. Owing to limited studies, the advantage of miniLPT should be evaluated more precisely by its technical development and more penetrating researches. There are huge gaps in standardized high-quality RCTs, performance and research of long-term outcomes and health economy comparing different approaches to total hysterectomy in China.
ObjectiveTo indirectly compare the efficacy and safety of bipolar radiofrequency ablation versus hysterectomy in abnormal uterine bleeding by using network meta-analysis. MethodsThe PubMed, EMbase, Web of Science, Cochrane Library, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy and safety of different surgical methods in abnormal uterine bleeding from inception to May 20, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Network meta-analysis was then performed by using Stata 16.0 software. ResultsA total of 39 RCTs involving 3 307 patients were included. The results of network meta-analysis showed that hysterectomy was superior to bipolar radiofrequency ablation in terms of amenorrhea rate and reintervention rate, while the hospital stay and patient satisfaction rate were opposite. ConclusionCurrent evidence shows that bipolar radiofrequency ablation has more advantages in terms of hospital stay and satisfaction rate, while hysterectomy has more advantages in terms of amenorrhea rate and reintervention rate. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Objective To assess the efficacy and safety of laparoscopic nerve-sparing radical hysterectomy (LNSRH) in treatment of early cervical cancer. Methods Such databases as CBM (1960 to September 2011), CENTRAL (1966 to September 2011), MEDLINE (1966 to September 2011), The Cochrane Library, EMbase (1974 to September 2011) and CNKI (1994 to September 2011) were searched on computer, and relevant magazines were also searched manually. Data were extracted and the quality was assessed after including studies according to exclusive criteria, then meta-analysis was conducted using RevMan 5.1 software. Results Total 7 studies involving 506 cases were selected, of which 255 cases were in the LNSRH group and the other 251 cases were in the laparoscopic radical hysterectomy (LRH) group. There were no differences between the two groups in age, body mass index, clinical stage, pathological type and histological grade. The results of meta-analysis showed that: a) The operative time of LNSRH was longer than LRH, with significant difference (P=0.02). But there was no significant difference in intraoperative bleeding between the two groups (P=0.69); b) The length of dissected parametrium of LNSRH was shorter than LRH with significant difference (P=0.02). But there was no significant difference in the length of dissected vagina (P=0.69); and c) The functional recovery of the bladder in the LNSRH group was better than LRH (Plt;0.000 01). Conclusion LNSRH is safe and feasible in effectively alleviating the postoperative dysfunction of the bladder in early cervical cancer as well as in improving the quality of life for patients. It is regarded as a new model of operation. Because it has just been put into practice within a short time, and there is lack of multi-center, large-sample, prospective controlled studies at present, so its radical effectiveness, long-term recurrence rate, survival rate, etc. have not yet been confirmed. More high quality studies are needed to provide important data of comparison between LNSRH and LRH.
目的:评价腹腔镜辅助阴式子宫切除术(LAVH)的临床价值。方法:对35例子宫良性病变者行LAVH手术的临床治疗进行分析,并与腹腔镜Doderlein式子宫切除术(LDH)32例进行比较。结果:两组手术在手术时间,术后镇痛,肛门排气时间,住院时间等方面差异无统计学意义,但术中出血量比较: LAVH组(96.2±58.56)mL, LDH组(186.2±62.5) mL,差异有统计学意义(Plt;0.05)。结论: LAVH手术镜处理子宫动脉,能有效控制术中出血量,值得临床推广应用。
目的:观察静脉应用小剂量氯胺酮超前镇痛法对接受腹腔镜下子宫切除手术患者术后疼痛及认知功能的影响。方法:38例择期接受腹腔镜下子宫切除术患者(ASA分级12)随机分为氯胺酮组和对照组。氯胺酮组于手术开始前5min静脉滴注氯胺酮015mg·kg-1,术中持续泵注3μg·kg-1·min-1至手术结束;对照组使用生理盐水。记录术中使用氯胺酮后心率,平均动脉压的变化;术后24h内静脉使用芬太尼的剂量,VAS疼痛评分,头晕、恶心、呕吐等不良反应,中枢神经系统症状以及术后2h患者认知功能。结果:两组患者在24h内静脉使用芬太尼的剂量,VAS疼痛评分,不良反应,中枢神经系统症状以及术后2h的认知功能方面没有统计学差异。〖HTH〗结论:〖HTSS〗静脉使用小剂量氯胺酮超前镇痛并不能减少术后芬太尼的用量,不能降低术后疼痛评分。尽管使用小剂量氯胺酮并没有增加患者术后的不良反应,也不影响患者术后认知功能障碍,不建议作为腹腔镜下子宫切除术患者常规使用。
【摘要】 目的 观察曲马多超前镇痛对经腹子宫切除术患者术后疼痛和恶心呕吐的影响。 方法 2008年11月-2009年5月，40例全身麻醉下行经腹子宫切除术的患者，分为超前镇痛组和对照组（n=20）。超前镇痛组和对照组于麻醉诱导前30 min分别静脉注射曲马多（3 mg/kg）和生理盐水。术后12、24 h，观察Bolus次数和芬太尼的用量，患者疼痛评分及术后恶心呕吐的发生率。 结果 术后12、24 h，曲马多超前镇痛组Bolus次数和芬太尼的用量均小于对照组（Plt;0.05），术后恶心呕吐的发生率差异无统计学意义（Pgt;0.05）。 结论 经腹子宫切除术手术前给予曲马多超前镇痛能够减少术后镇痛药的需要量，且不增加术后恶心呕吐的发生率。【Abstract】 Objective To observe the effects of tramadonl preemptive analgesia on postoperative pain and postoperative nausea and vomiting (PONV) in patients with hysterectomy. Methods Form November 2008 to May 2009, fourty patients who had undergone hysterectomy were divided into preemptive analgesia (PA) group and control group, 20 patients in each. The PA and control group were intravenously injected with tramadol (3 mg/kg) and normal saline respectively. Twelve and 24 hours after hysterectomy, the Bolus times, consumption of fentanil, pain score and incidence of PONV were observed. Results Twelve and 24 hours after hysterectomy, the Bolus times and consumption of fentanil were both lower than those in control group(Plt;0.05), the difference of PONV incidences between two groups was not statistically significant (Pgt;0.05). Conclusion Intravenously injected with tramadol before hysterectomy can recduce the dosage of analgesic, and don′t increase the incidence of PONV.