OBJECTIVETo compare the clinical characteristics of three subcategories of laparoscopic hysterectomy: total laparoscopic hysterectomy (TLH) and two subcategories of laparoscopic-assisted vaginal hysterectomy (LAVH): LAVHs and LAVHb.

METHODSWe retrospectively analyzed the clinical data of 393 patients underwent laparoscopic hysterectomy, including TLH (n=178), LAVHa (n=177), and LAVHb (n=38), in our hospital from September 2002 to September 2005.

RESULTSMyoma and adenomyosis of uterus were the most common diseases in this study, accounting for 66.9%, 38.4%, and 52.6% in TLH group, LAVHa group, and LAVHb group, respectively. The mean surgery duration and blood loss were not significantly different between TLH group and LAVHa group (P > 0.05), but were significantly less in TLH group than in LAVHb group (P < 0.05). The bulk of uterus in TLH group was significantly bigger than in other two groups (P < 0.05). The incidence of major complications in the TLH group (9. 0%) was lower than in LAVHa group (14.1%) and in LAVHb group (18.4%), but without statistical significance. Conclusion Compared with LAVH, TLH is feasible to deal with bigger uterus with less blood loss and shorter surgery duration and without more frequent complications.

Endometriosis ; surgery ; Female ; Humans ; Hysterectomy ; adverse effects ; methods ; Hysterectomy, Vaginal ; adverse effects ; methods ; Laparoscopy ; adverse effects ; methods ; Myoma ; surgery ; Retrospective Studies ; Uterine Neoplasms ; surgery

OBJECTIVETo investigate ureteral injury during gynecological laparoscopic surgeries.

METHODSFrom January 1990 to December 2005, 12 868 gynecological laparoscopic surgeries were conducted in Peking Union Medical College Hospital with 12 ureteral injuries reported. The present study investigated several aspects, including surgical indications, uterine size, pelvic adhesion, operative procedures, symptoms, diagnostic time and methods, injury site and type, subsequent treatment, and prognosis.

RESULTSThe incidence of ureteral injury was 0.093% (12/12 868) in all cases, 0.42% (11/2 586) in laparoscopic hysterectomy [laparoscopically assisted vaginal hysterectomy (LAVH) or total laparoscopic hysterectomy (TLH)], and 0.01% (1/10 282) in non-LAVH surgeries. Enlarged uterus, pelvic adhesion, and endometrosis were risk factors associated with ureteral injury. Only one injury was found intraoperatively while others were found postoperatively. The injury sites were at the pelvic brim (2 cases) or the lower part of ureter (10 cases). Patients were treated with ureteral stenting (effective in 2 cases) or laparotomy and open repair. Prognoses were favorable in most cases.

CONCLUSIONSMost laparoscopic ureteral injuries occur during laparoscopic hysterectomy. Further evaluation is required when ureteral injury is suspected, and surgical repair is the major treatment for ureteral injury.

Female ; Gynecologic Surgical Procedures ; adverse effects ; Humans ; Hysterectomy ; adverse effects ; Laparoscopy ; adverse effects ; Ovariectomy ; adverse effects ; Retrospective Studies ; Tissue Adhesions ; therapy ; Treatment Outcome ; Ureter ; injuries

Adult ; Drainage ; Female ; Humans ; Hysterectomy, Vaginal ; adverse effects ; Laparoscopy ; adverse effects ; Radiography ; Subphrenic Abscess ; diagnostic imaging ; etiology ; therapy ; Ultrasonography

OBJECTIVETo investigate the influences of total abdominal and laparoscopically hysterectomy on coagulation and fibrinolytic functions.

METHODSBlood samples were taken from 20 patients without high-risk factor of thrombosis before and after total abdominal and laparoscopically hysterectomy. The values of PT, APTT, FG, D-Dimer and AT-III were measured.

RESULTSThe values of PT and AT-III significantly decreased while D-Dimer significantly increased after the operations. These changes were more obvious in patients undergoing abdominal hysterectomy. No significant changes in APTT or FG were noted after hysterectomy.

CONCLUSIONSPatients undergoing hysterectomy are at risk of developing thromboembolism, but the laparoscopic approach can significantly lower this risk as compared with abdominal hysterectomy.

Blood Coagulation Tests ; Female ; Humans ; Hysterectomy ; adverse effects ; methods ; Laparoscopy ; adverse effects ; Partial Thromboplastin Time ; Risk Factors ; Thromboembolism ; diagnosis ; etiology

OBJECTIVETo initially observe the effect of classical endotracheal intubation on endotracheal bacterial contamination and evaluate the validity of protective endotracheal intubation on reducing endotracheal bacterial contamination.

METHODSNinety elective patients undergoing general anesthesia for hysterectomy were randomly assigned to two equal groups. Group II received endotracheal intubation protected by sterilized transparent sleeve while group I correspondingly adopted unprotective classical endotracheal intubation. Endotracheal swab sampling and bacterial counting were performed on the principle of aseptic processing before endotracheal intubation and extubation, respectively.

RESULTSBacteria were found in 62 of 180 samples. The difference of bacterial counting between before extubation and before intubation was (-0.3 +/- 35.6) 100 CFU/ ml in group II, lower than that in group I, which was (21.4 +/- 56.7) 100 CFU/ml (P<0.05).

CONCLUSIONEndotracheal bacterial contamination may be caused by unprotective classical endotracheal intubation and could be reduced by protective endotracheal intubation.

Anesthesia, General ; Bacteria ; isolation & purification ; Female ; Humans ; Hysterectomy ; Intubation, Intratracheal ; adverse effects ; methods ; Trachea ; microbiology

No abstract available.
Female ; Humans ; Hysterectomy/adverse effects/*methods ; Postoperative Complications/*prevention & control ; Urinary Bladder/*innervation/physiopathology ; Urodynamics/*physiology

BACKGROUND/AIMS: This study was aimed to analyze the clinical characteristics of patients who developed constipation after radical hysterectomy or delivery and to investigate the results of biofeedback therapy for these patients. METHODS: Thirty-five chronic constipation patients with radical hysterectomy (radical hysterectomy group), 27 chronic constipation patients with delivery (delivery group) and 27 constipation patients with no history of hysterectomy or delivery (control group) were included. Clinical characteristics of these patients, including the results of biofeedback therapy, were analyzed. RESULTS: The delivery group showed higher rates of pelvic floor dyssynergia than the control group (14/27, 52% vs. 6/27, 22%; p<0.05). The prevalence of slow transit constipation was lower in the radical hysterectomy group and delivery group than in the control group (7/35, 20% and 5/27, 19% vs. 12/27, 44%; p<0.05). The prevalence of anatomical abnormalities was not different between the groups. The radical hysterectomy group showed higher rate of obstructive sensation and the delivery group showed higher rate of hard stool and digital maneuvers. The biofeedback therapy was effective in 10 out of 12 patients (91%) among the radical hysterectomy and delivery group. CONCLUSIONS: Radical hysterectomy and delivery seem to induce functional constipation, which may be caused by anorectal dysfunction such as pelvic floor dyssynergia. The biofeedback treatment was effective in functional constipation after radical hysterectomy or delivery.
Adult ; Aged ; Chronic Disease ; Constipation/diagnosis/*etiology/therapy ; Delivery, Obstetric/*adverse effects ; English Abstract ; Female ; Humans ; Hysterectomy/*adverse effects ; Middle Aged

Sclerosing encapsulating peritonitis (SEP) is a poorly understood and rarely documented cause of small bowel obstruction. Although recurrent peritonitis has been reported as the main contributory factor leading to secondary SEP, the pathogenesis of primary (idiopathic) SEP is still uncertain. A 40-year-old woman with a history of total abdominal hysterectomy due to gestational trophoblastic disease presented with progressive lower abdominal pain and abdominal distension. Ultrasonography and contrast-enhanced abdomen-pelvis computed tomography of the abdomen revealed encapsulation of the entire small bowel with a sclerotic capsule. At laparotomy, a fibrous thick capsule encasing small bowel loops was revealed. Extensive adhesiolysis and removal of the capsule from the bowel loops were performed. The patient recovered uneventfully; she was discharged without complications. SEP is a rare cause of small bowel obstruction. We treated a case of abdominal cocoon with intestinal partial obstruction in a woman with a history of abdominal hysterectomy due to gestational trophoblastic disease. Surgical treatment was effective and the patient recovered without complication.
Adult ; Female ; Humans ; Hysterectomy/*adverse effects ; Intestinal Obstruction/diagnosis/*etiology ; Intestine, Small/*pathology ; Peritonitis/diagnosis/*etiology/surgery ; Sclerosis/*pathology

Adult ; Embryo Transfer ; Female ; Fertilization in Vitro ; Humans ; Hysterectomy ; adverse effects ; methods ; Pregnancy ; Pregnancy Outcome ; Pregnancy Trimester, Second ; Risk Factors

Acupuncture Therapy ; Adult ; Female ; Humans ; Hysterectomy ; adverse effects ; Nocturnal Enuresis ; etiology ; therapy ; Ovary ; surgery ; Postoperative Complications ; etiology ; therapy