ISSN:1077-2847    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1077-2847    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

ObjectiveTo study the feasibility of endoscopic approach and modified instrumentation for the Vecchietti operation to create a neovagina in young patients with congenital vaginal aplasia.Study DesignRetrospective analysis of the experience with the modified instrumentation and retrospective analysis of perioperative and postoperative results in the first 20 patients treated endoscopically at the department of Gynecology and Obstetrics. Heinrich-Heine-University. Düsseldorf. Germany.ResultsThe change in instrumentation eased the postoperative phase for the patients in the way that they were more mobile and vaginal examinations could be abandoned in comparison to the original Vecchietti instrumentation. Furthermore, the introduction of laparoscopy improved this even more. Endoscopy did help to gain access to the retrovesical space more precisely than by laparotomy. No major complications were encountered.ConclusionsThe endoscopic approach should become the method of choice for the Vecchietti operation because it avoids the known disadvantages of laparotomy and gives better visualization of retroperitoneal pelvic anatomy. Our change in instrumentation helps the patient to move more freely in the postoperative phase, which is the decisive one in this distension method for creating the neovagina.

ISSN:1077-2847    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

ObjectiveWe reviewed our experience with vaginal hysterectomy in patients with benign uterine enlargement in order to 1) identify factors associated with success in using the vaginal approach, and 2) to identify morbidity associated with vaginal hysterectomy in these patients when compared to similar patients undergoing abdominal hysterectomy.MethodsComputerized pathology reports for all women who underwent hysterectomy at the Mayo Medical Center between 1990 and 1992 were reviewed to identify patients whose uterus weighed between 200 and 600 grams. Patients with adnexal masses and malignancy were excluded. Medical records were reviewed to identify and compare patients who underwent vaginal hysterectomy and those who underwent abdominal hysterectomy. Statistical analysis was performed using the2test, Fisher's exact test, and Student's t-tests.ResultsOf the 298 patients who met criteria for study, 115 (38.6%) were considered candidates for the vaginal approach, and in 111 of these patients (96.5%) the vaginal hysterectomy was successful. Morcellation was required for uterine removal in 78 patients who underwent vaginal hysterectomy (70.3%). Nulliparity, previous pelvic surgery, and endometriosis were significantly less common in patients who underwent vaginal hysterectomy than in similar patients who underwent abdominal hysterectomy, and when patients with these factors were excluded, the percentage of cases done vaginally increased from 37.3% to 51.4%. The percentage of vaginal hysterectomies decreased significantly as uterine weight increased. Vaginal hysterectomy was done in only 11.2% of patients with uterine weight above 400 grams, but in 47.7% of patients with uterine weight between 200 and 400 grams. Hospital stay was significantly shorter for the vaginal group than the abdominal group (4.5 days versus 5.7 days;P< 0.001). The overall complication rate was 17% for patients who had vaginal hysterectomy and 40% for those who had abdominal hysterectomy(P< 0.001).ConclusionsVaginal hysterectomy in patients with benign uterine enlargement is associated with significantly shorter operative time, shorter hospitalization, and fewer complications than abdominal hysterectomy in similar patients. Although the vaginal approach is used significantly less often in patients with nulliparity, previous pelvic surgery, endometriosis, and uterine weight greater than 400 grams, these factors are not contraindications to vaginal hysterectomy in patients with uterine enlargement who have sufficient uterine mobility and accessibility.

ISSN:1077-2847    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

BackgroundUltraradical surgery, such as pelvic exenteration, is on occasion employed in the treatment of gynecologic malignancies. Because the percentage of elderly women in most developed countries is increasing, it is important to determine whether such surgery carries too high a morbidity and mortality to be performed in those patients. Therefore, a retrospective study of patients aged 65 years or older having a pelvic exenteration was undertaken.MethodsA retrospective case study of all patients at least 65 years old undergoing pelvic exenteration by a single gynecologic oncologist was performed. All patients were examined for preexisting medical conditions, length of postoperative stay, morbidity, mortality, and length of survival. Comparison was made with patients younger than 65 years old undergoing pelvic exenteration in the same surgeon's practice.ResultsTwenty-one patients 65 years or older and 46 patients younger than 65 years old were identified. Preexisting medical conditions were found in 69.6% of the study population (age 65 or older) and 21.7% of the younger population (younger than 65 years old)(P <0.001). Minor morbidity occurred in 33.3% and 15.2% of the study and younger groups(P= 0.09), respectively, whereas major morbidity occurred in 28.6% and 37.0% of the study and younger groups(P =0.51), respectively. The incidence of surgical mortality was 9.5% and 6.5% of the older and younger groups(P =0.47), respectively. Mean lengths of hospital stay were not significantly different between patients younger than 65 years old (27.6 days), and those 65 years or older (25.9 days)(P= 0.32). Mean length of survival was also not significantly different for those younger than 65 years old (54.2 months) and those 65 years or older (54.8 months)(P =0.95). Actuarial survival at 10 years for patients 65 years or older was 31.3%, and 32.5% for patients younger than 65 years old(P= 0.90).ConclusionsPelvic exenteration is a reasonable procedure in elderly patients.

ISSN:1077-2847    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1077-2847    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1077-2847    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1077-2847    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1077-2847    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1077-2847    

出版商:OVID    

年代:1995

数据来源: OVID