단순 복강경하 전자궁적출술 312예에대한 임상적 분석
Simple Total Laparoscopic Hysterectomy: A clinical Evaluation of 312 Cases
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목적 : 본원에서 시행한 단순 복강경하 전자궁적출술의 수술적응증, 수술시간, 수술 후 재원기간, 수술 전후 혈색소치의 변화, 합병증 등을 고찰하여 그 의학적 효용성을 분석하고자 한다. 연구 방법 : 2002년 1월부터 2003년 6월까지 포천중문의과대학 구미차병원 및 강남차병원에서 단순 복강경하 전자궁적출술을 시행한 312명의 환자를 대상으로 하였다. 결과 : 환자의 평균연령은 45.2세, 평균 출산력은 2.2회, 적출된 자궁의 평균무게는 272.3 gm이었다. 수술적응증은 자궁근종 136예 (43.5%), 자궁선근증 90예 (28.8%), 자궁근종 및 선근증이 동반된 경우가 52예 (16.6%), 자궁탈출증 15예 (4.8%), 고등급 편평상피내 손상 (HSIL) 19예 (6.1%) 이었다. 동반 수술로는 자궁부속기 절제술, 유착박리술, 질벽성형술, TVT (Tension free vaginal tape) 등이었다. 평균 수술시간은 107분 (마취기준), 평균 재원 일수는 5.2일, 수술 전후 혈색소치 감소는 1.2 gm/dL로 나타났다. 수술 후 합병증으로는 요관 손상 2예, 장관 손상 1예, 질봉합부위 출혈 1예가 발생하였으나 적절한 조치 후 별다른 문제없이 퇴원하였다. 결론 : 단순 복강경하 전자궁적출술 시행시 수술팀의 숙련도 여부가 가장 중요한 요소로 생각되며, 그 장점은 수술기법이 보다 단순하고, 경제적이며, 합병증의 감소라 할 수 있으므로, 단순 복강경하 전자궁적출술은 기존의 복강경하 전자궁적출술이나 기타 다른 자궁적출술을 대체하는데 조금도 손색이 없는 수술법으로 생각된다.
Abstract
Objective : This study was conducted to evaluate the clinical efficacy of simple total laparoscopic hysterectomy in the aspect of operation indication, operation time, hospitalization day, blood loss, and postoperative complications. Methods : A retrospective evaluation for 312 women who undergone simplified total laparoscopic hysterectomy from January, 2002 to June, 2003 was done. Results : The mean age of patients was 45.2 years, mean parity was 2.2, and mean uterine weight was 272.3 gm. The most common surgical indication was uterine myoma in 136 cases (43.5%), followed by adenomyosis in 90 cases (28.8%), myoma combined with adenomyosis in 52 cases (16.6%), uterine prolapse in 15 cases (4.8%), and HSIL 19 cases (6%) respectively. The most common concomitant operation was salpingooophorectomy in 53 cases (16.9%), followed by adhesiolysis in 40 cases (12.8%), colporraphy in 14 cases (4.4%), electrocauterization (ovary) in 4 cases (1.3%), pelvic floor suspension in 4 cases (1.3%), and TVT in 1 case (0.3%). The mean operation time was 107 minutes, and the average hospital day was 5.2 days. The preoperative and postoperative hemoglobin difference was 1.2 gm/dL. The complications of STLH were ureteral injury in 2 cases, intestinal injury in 1 case, and stump bleeding in 1 case. Conclusion : The most important factors for successful STLH were sufficiently trained laparoscopic team and the degree of pelvic adhesion. The most potential advantages of STLH are shorter duration of operation time, hospitalization, and less postoperative complications and more cost effectiveness. Therefore, STLH can be a new alternative option for hysterectomy and may replace the other methods of hysterectomy such as abdominal, vaginal and laparoscopic assisted vaginal hysterectomy (LAVH).
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