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Objective To analyze incidence,pathogenesis and treatment of the complications of transvaginal hysterectomy(TVH)collected during past six years,and to discuss the possible methods of prevention.Methods The patients involved in present study were admitted and underwent the transvaginal hysterectomy in the General Hospital of PLA from Jan.2000 to Jun.2006.The data of complications occurred at intra-or post-operation were retrospectively analyzed.Results Among all of the 1990 cases with TVH,complications occurred in 75 cases,the incidence of complication was 3.77%,including 21 cases of bladder injury(1.06%),5 cases of ureter trauma(0.25%),6 cases of rectal injury(0.3%),30 cases of vaginal stump inflammation(1.51%),8 cases of vaginal stump haematoma(0.4%),2 cases of intra-abdominal hemorrhage(0.1%),2 cases of vaginal narrowness(0.1%)and 1 case of intestinal obstruction(0.05%).The bladder injury and vaginal stump inflammation almost toke the two third of total cases.Some complications were got correction by surgery appropriately during or after the operation when injuries were found.Some cases were managed by conservative treatment.All of the patients with complications were healed without any sequelae.The organ injuries occurred more easily in the cases with pelvic adhesion or less movable large uteri,such as the cases with the history of pelvic operation,the endometriosis or the lower segment myoma.Conclusions The organs adjoined to uterus were easily damaged by TVH during the performance of operation,and the corresponding complications are common after the operations.The operator should familiar with the pelvic anatomy,master the skilled surgical techniques and suitably control the indications of the TVH.With the improvement of techniques in TVH and the research of new instrument applied in this procedure,the incidence of complications in TVH would be further reduced.
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Objective To evaluate the feasibility and efficacy of treatment of leukoplakia vulvae with high-intensity focused ultrasound. Methods 65 patients with leukoplakia of the vulva were treated with high-intensity focused ultrasound. The patients were followed up after the treatment, and the symptoms including itch of the vulva, color change, the elasticity of the vulva lesions, and release of adhesions were observed and evaluated at the different times after treatment. Result All of the patients experienced relief in different degree (the ratio of effectiveness was 100%). Of them 28 patients were complete cured, 29 were distinctly improved, 8 were improved. In 5 patients there was a recrudescence with mild itch 2-3 months after treatment, but there was still a positive response to the second course of treatment. Conclusions High-intensity focused ultrasound is a highly effective instrument in the treatment of leukoplakia of the vulva. The treatment not only stops itch, but enables the color and elasticity of the vulva to recover as well.
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Objective To evaluate the feasibility and advantages of transvaginal hysterectomy (TVH) for enlarged uterus without prolapse. Methods Six hundred and ninety-six patients underwent TVH for gynecological disorders from Sept, 1998 to Dec, 2002. Meanwhile, the method of operation, complications of surgery, operation time, estimated operative blood loss, postoperative recovery and hospital stay days were retrospectively analyzed. Results The operation was successful in 693 out of 696 cases (99.6%). The mean operative time was 49.3 minutes (11-125 minutes). The estimated blood loss was 69.7ml (15-450ml). Operative injuries were found in 3 patients (0.4%). Complications attributable to surgery were found in 6 cases (1%). The mean time of subsidence of fever was 1.2 days (0-5 days) and the time of passing flatus was 22.6 hours (8-32 hours). The average hospital stay was 5.3 days (4-15 days). Conclusion TVH can be performed safely for most of non-prolapsed large uterus. Because it has the advantages of less bleeding, short operating time, rapid recovery and less cost compared to TAH and LAVH, it is our opinion it should be the first option for enlarged uterus.
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Objective To detect the expression of lysyl oxidase (LOX) in pelvic floor tissues and the serum copper ions level of the women with stress urinary incontinence (SUI) for exploring the role of LOX in SUI pathogenesis. Methods The sera of 25 patients with SUI were collected before the operation. The content of serum copper was measured by the technique of atomic absorption spectrum. Meanwhile, 25 patients with similar age but suffering from benign gynecological diseases and undergone total hysterectomy were enrolled as control. Biopsy specimens were obtained from the uterine cardinal sacral ligament of the patients with and without SUI during the operation. The histological structure of pelvic collagen fiber was examined with routine HE staining and Van Gieson (VG) staining. Immunohistochemistry was used to determine the location of LOX. Protein expression of the LOX in pelvic floor tissue was analyzed by Western blotting. Results There was no statistical difference in serum copper content between SUI group and the control group. In the HE and VG staining sections, collagen fiber density of pelvic tissue in SUI group was decreased and fibers were arranged disorderly. Immunohistochemistry showed that LOX was mainly expressed in the cytoplasm of fibroblast. The number of positive cells in pelvic tissues of the patients with SUI was smaller than that in the control group, and the positive signal in SUI group was weaker than that in the control group. The gray degree values of SUI group was obviously lower than that of the control group (P
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Objective To evaluate the advantages and feasibility of transvaginal excision of ovarian tumor. Methods A series of 62 patients with ovarian benign tumors had the tumors excised transvaginally from Dec 2001 to Oct 2003. The indications of transvaginal surgery, the method of operation, the complications following the operation, the overall operation time, the estimated blood loss during operation, the postoperative complications, and hospital stay days were analyzed retrospectively. Results Transvaginal ovarian tumor excision was successfully completed with neither the aid of laparoscopy or shift to laparotomy. No intra-abdominal spillage of cystic contents occurred. The mean operation time was 39.4 minutes. The estimated blood loss was 37.5ml. No postoperative complications occurred. The mean length of a low fever was 1.3 days, and the time of recovery of bowel movement was 20.1 hours. The average hospital stay was 4.2 days. Conclusion For free benign ovarian tumors, the transvaginal route should be considered to minimize trauma. There would be no skin incision, and it could be carried out in patients who had relatively large ovarian tumors with no intra-abdominal spillage. There would be less blood loss, shorter operation time, shorter hospital stay and lower cost.
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Objective To evaluate the feasibility and advantages of the excision of uterine fibroids by vaginal myomectomy. Methods A series of 58 patients with uterine fibroids were managed with myomectomy from May 2001 to Dec 2003. Meanwhile, the indications of vaginal surgery, the methods of operation, the complications of surgery, the overall operating time, the estimated operative blood loss, the postoperative recovery and hospital stay were explored. Results Myomectomy were successfully completed vaginally without shifting laparotomy in 57 patients. The successful rate was 98 3%. The mean operative time was 48 16 minutes. The estimated blood loss was 70 58ml. The postoperative complication was occurred in one patient with uterine infection. The mean length of lower fever was 1 8 days and the bower movement was 1 3 days. The average hospital stay was 4 9 days. Conclusions For uterine fibroids, the vaginal myomectomy is a good choice when the indication of operation are managed properly. It can be used in patients who have numerous, relatively large, and intramural fibroids with micro invasive surgery, little interfering with abdominal organs, less blood loss, less operating time, less cost and less hospital stay in comparison with abdominal myomectomy or laparoscopic myomectomy
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Objective To evaluate the usefulness of the LigaSure vessel sealing system for vascular control during transvaginal hysterectomy and compared it with suture group. Methods One hundred and sixty-one transvaginal hysterectomy were performed with LigaSure while 62 with traditional suture from Sept 2002 to Mar 2003. Meanwhile, the operating time, the estimated blood loss, the postoperative recovery and hospital stay were explored. Results All of the surgery were successfully performed with both LigaSure and traditional suture. Compared with suture group the LigaSure has many advantages in operating time, estimated blood loss and postoperative recovery. Conclusion For transvaginal hysterectomy LigaSure vessel sealing system is a more useful instrument and also an ideal option. It may be used safely in large, difficult uterus during transvaginal hysterectomy with less blood lose, short operating time, quick recovery after surgery.