腹腔鏡下子宮全摘術時の腟断端止血操作を減らすことで腟断端離開を減らす可能性がある

抄録

Objective: Previous studies have reported an increased risk of vaginal cuff dehiscence following total laparoscopic hysterectomy (TLH) compared with that following total abdominal hysterectomy or vaginal hysterectomy. Although vaginal cuff dehiscence after TLH is rare, it often results in severe complications, and although the cause remains unknown, the use of energy devices in vaginal incision has been implicated. This study investigated whether reducing coagulation hemostasis decreases the risk of vaginal cuff dehiscence.

Methods: A total of 863 cases of TLH were analyzed from January 2016 to December 2017 at our hospital. We modified the method of hemostasis of vaginal cuff since January 2017. We followed different methods for hemostasis of the vaginal cuff between January and December 2016 (group A, complete hemostasis) and between January and December 2017 (group B, almost complete hemostasis, except in case of heavy hemorrhage). Group A included 352 cases, and group B included 511 cases. Vaginal dehiscence rates in the two groups were compared using the χ2 test.

Results: Vaginal cuff dehiscence was observed in four cases (1.1%) in group A and two cases (0.3%) in group B, which showed drastic reduction. However, no significant difference (p=0.2) was noted. Sexual intercourse was found to be the biggest trigger for the complication (50%).

Conclusions: Based on our results, we recommend that decreasing the vaginal cuff coagulation hemostasis can reduce vaginal cuff dehiscence following TLH.