Comparision of Vaginal Hysterectomy and Abdominal Hysterectomy for a Nonprolapsed, Benign Uterine Disease in Women Without Vaginal Delivery / 대한산부인과학회잡지

OBJECTIVE: This study was designed to compare the vaginal hysterectomy and abdominal hysterectomy for a non-prolapsed, benign uterus in women without vaginal delivery. METHODS: A retrospective study in Hallym-university hospital analysed 182 total hysterectomies in women without vaginal delivery performed from January 2000 to December 2001. Vaginal route was used for 98 (53.8%) patients and 84 (46.2%) had laparotomies. RESULTS: The mean uterine weight was 217 g in vaginal route, 270 g in abdominal route. Mean operation time was 70 minutes in vaginal route, 125 minutes in abdominal route. There was one serious re-operation due to hemorrhge in each group and other complication was not much different at each gruops. The hospital stay was 6.2 days in vaginal route and 8.4 days in abdominal route. CONCLUSION: Vaginal hysterectomy for a non-prolapsed uterus is indicated for women without vaginal delivery and is feasible to performance. Vaginal hyterectomy is less morbidity, shorter hospitalization and faster convalescence. So training in vaginal surgury should allow safe performance of the procedure at most center.

Prediction of Residual Lesion based on Histopathology and Margin Status of Conization Specimens Related to Post-cone Hysterectomy / 대한산부인과학회잡지

OBJECTIVE: The objective of this study is to evaluate predictive factors for residual lesion after conization in patients with cervical neoplasia. METHODS: we performed retrospective study (between January 1996 and June 2002) and reviewed 146 patients who had undergone cervical conization followed by subsequent hysterectomy. The age and the parity of patients, the histopathology and the status of resection margins of cone specimens were analysed as predictive values of residual lesions. RESULTS: The prevalence rate of positive cone margins were 0%, 15%, 43.4%, and 85.7% respectively in patients with low-grade squamous intraepithelial lesion (LSIL) (n=3), high-grade squamous intraepithelial lesion (HSIL) (n=60), Cervical cancer stage I a1 (CC-I a1) (n=76) and Cervical cancer stage I a2 (CC- I a2) (n=7). The prevalence rates of positive residual lesions in post-cone hysterectomy specimens were 0%, 23.3%, 35.5%, and 100% respectively in those with LSIL, HSIL, CC- I a1, and CC- I a2. Residual lesions were significantly more frequently found in patients with positive cone margin (56.3%) than in those with negative margin (21.4%) (P value=0.000026). Positive predictive values of margin status for the presence of residual lesions were 0% (LSIL), 22.2% (HSIL), 57.6% (CC- I a1) and 100% (CC- I a2). Negative predictive values of margin status for the absence of residual lesions were 100% (LSIL), 76.5% (HSIL), 81.4% (CC- I a1) and 0% (CC- I a2). Only 8.3% (4/48) of patients with positive cone margin had more advanced residual lesions. 9.2% (9/98) of patients with negative margins had invasive residual lesion. CONCLUSION: The prevalence rate of positive cone margin and residual lesion increased with high severity of cervical neoplasia. Patients with positive cone margin had significantly higher chances of having residual lesion than those with negative margin. Free cone margin does not ensure the absence of residual lesion in the remaining cervix. Positive cone margin does not invariably indicate the presence and persistence of more severe residual lesion. Subsequent hysterectomy may be reserved for the patients with invasive cone pathology, concomitant morbid uterine condition, or not reliable for continuous follow-up.