当院におけるTLHの開腹移行に寄与する因子の後方視的検討

抄録

Objective: To identify the risk factors involved in the conversion to laparotomy during total laparoscopic hysterectomy (TLH) for benign diseases.

Design: Retrospective comparative study

Setting: Kaizuka Municipal Hospital for gynecologic endoscopic surgery.

Patients: 453 patients who underwent TLH during the last four years of our performance of TLH.

Intervention: Total laparoscopic hysterectomy for benign disease. We compared patient characteristics(Age, Body Mass Index, history of abdominopelvic surgery, comorbidity of endometriosis), indications for hysterectomy, uterine width on Magnetic Resonance Imaging (MRI), operation time, blood loss, adhesion, uterine weight and complications between a failed and a successful group.

Main outcome measures: The rate of conversion to laparotomy was 1.9% (nine patients). There were no differences in patient age and BMI between the two groups. An independent risk factor for conversion was uterine width greater than 10 cm on MRI (p=0.0009). Operation time, blood loss and uterine weight were greater in the group with a uterine width that was greater than 10 cm on MRI. Adhesion, history of abdominopelvic surgery and comorbidity of endometriosis were not independent risk factors for conversion in this study. (p=0.0589, p=0.8503, p=0.5394).

Conclusion: Uterine width greater than 10 cm on MRI is a risk factor for conversion to laparotomy. Awareness of the risk factors for conversion to laparotomy is essential for better patient selection for TLH.