본 연구는 202명의 골반경에 의한 질식 전자궁적출술 환자를 대상으로 복식 자궁적출술이 나 질식 자궁적출술에 비해 부작용이 적고 여러가지 장점이 있기 때문에, 개복을 하여 자궁 적출술을 시행할 수 밖에 없었던 많은 환자를 골반경을 통하여 방해되는 인자를 제거하여 질 식 자궁적출술을 가능하게 함으로써 복식 자궁적출술 대상 환자의 상당부분을 골반경에 의한 질식 전자궁적출술로 전환시켜 성공적으로 치료할 수 있음을 보여주었다. 그러나 이 수술방법의 평가는 어떠한 결론을 내리기 전에 더 많은 환자에서 추적 조사가 필 요할 것으로 사료된다.
From January, 1991, to October 1992, 202 pelviscopically assisted vaginal hysterectomy (PAVH) were performed at Department of 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 palsy. The mean operating time was 110 minutes and the mean estimated blood loss was 1.2gm/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 and recovery. This pelviscopic procedure provided us to determine whether to do the vaginal hysterectomy, and furthermore, made it possible to change most of the abdominal hysterectomies to PAVH.
