抄録
Objectives: Laparoscopic surgery is widely used as a therapy for gynecologic diseases. However, there are few reports with respect to the hydration status of patients during laparoscopic surgery. It is suspected that insensible water loss is reduced during laparoscopic surgery because a laparotomy is not performed. However, further studies are required to confirm this notion and ensure that fluid balance is regulated appropriately during laparoscopic surgery. The aim of the current study was to determine the fluid balance of patients undergoing total laparoscopic hysterectomy (TLH) in comparison with vaginal hysterectomy (VH) and total abdominal hysterectomy (TAH).
Methods: All surgical procedures were performed under general anesthesia. We analyzed the volume of intra-operative bleeding, urine, and transfusion, and calculated the third space losses in 37 patients who underwent VH, TAH, or TLH in the Ehime University Hospital between December 2007 and April 2009. Statistical analysis was performed by ANOVA. The differences were statistically significant at a p<0.05, and the results were recorded as the mean average ± standard error of the mean.
Results: The amount of bleeding, urine output, and transfusion per hour was significantly increased in patients undergoing TAHs. Third space loss was significantly increased in patients undergoing TLHs (7.7±0.7 mL/kg/h; p<0.05) and VHs (5.7±0.6 mL/kg/h; p<0.05).
Conclusions: Third space loss was significantly increased during TLH, suggesting that the loss was caused by evaporation into the carbon dioxide aeroperitoneum and as a result of electrocoagulation. Given these results, we should reconsider the issue of third space loss during laparoscopic surgery and manage fluid balance accordingly during TLH.
