[Clinical study of delivery method in modified vaginal hysterectomy for large uterus].

OBJECTIVE: To prospectively explore the techniques, feasibility and safety of modified vaginal hysterectomy for large uterus. METHODS: A total of 158 patients undergoing hysterectomy at Beijing Hospital from January 2008 to December 2010 were divided into three groups: 12-16 gestational weeks large uterus for vaginal hysterectomy (n = 65, group 1), 12-16 gestational weeks uterus for abdominal hysterectomy (n = 47, group 2) and <10 gestational weeks uterus for vaginal hysterectomy (n = 46, group 3). The pattern and techniques of delivery in group 1 was based on the location of fibroids/adenomyoma (in anterior wall, posterior wall, uterine horn or broad ligament, cervix) and the direction of overall shape maximum diameter (direction towards abdomen defined as long type while the direction towards lateral pelvic wall wide type). The completion and safety were observed intraoperatively. The outpatient follow-up period was 1 month. RESULTS: A total of 158 cases of hysterectomy were performed successfully. The locations of fibroids/adenomyoma included anterior wall (n = 17), posterior wall (n = 24), unilateral uterine horn (n = 6), broad ligament (n = 3) and cervix (n = 2). in group 1, and there were long (n = 6) and wide (n = 7) types. They were all successfully delivered through vagina through various techniques. No case was converted into laparotomy. The average largest size (judged by as large as number of gestational weeks) and weight of uterus was group 2 and followed by group 1. But the difference of size and weight between two groups was insignificant (P > 0.05). Sorted by mean operative duration, mean amount of bleeding and decrease of hemoglobin, the declining order was the group 2, group 1 and group 3. The amount of bleeding for group 1 was less than that for group 2 (P < 0.05). But it was more than group 3 (P > 0.05). According to postoperative hospitalization duration, flatus time and indwelling catheter time, no statistical differences existed between groups 1 and 3. But the values of group 1 were significantly better than those of group 2 (P < 0.01, <0.05, <0.01). CONCLUSION: Vaginal hysterectomy is a safe and effective option for removing enlarged uterus. This pattern of operation can reduce the postoperative hospitalization time, flatus time and indwelling catheter time.

[Vaginal repair operation for anterior pelvic organ prolapse in elderly women].

OBJECTIVE: To identify the safety and efficacy of individualized vaginal surgery for anterior pelvic organ prolapse (POP) in elderly women so as to provide a clinical basis for studies on improving life quality by treatment in elderly women. METHODS: The individuation group consisted of 90 patients with a diagnosis of anterior POP. All over 60 years old, they underwent individualized vaginal surgery. The safety and efficacy, POP quantitative examination POP-Q change, cure and recurrence rate and life quality scores on incontinence and pelvic floor distress and impact were assessed. The control group (n = 60) was composed of patients (> 60 yr old) with a diagnosis of anterior POP were performed with Kelly-Kennedy operation. Their safety, efficacy, cure and recurrence rates were compared. RESULTS: Individualized vaginal surgery in elderly women was both safe and effective. The post-therapeutic recovery time was shorter (P < 0.05), the cure rate higher and the recurrence rate lower (P < 0.05) than that of control group. The life quality after individualized surgery improved (P < 0.01). CONCLUSION: The individualized vaginal surgery is safe and effective for a correction of anterior POP in elderly women. The life quality improves after operation.