The Clinical Study Of Vaginal Hysterectomy

Objective: The study was designed to check the feasibility of the vaginal route as the primary route for the hysterectomy, and to evaluate incidence , characteristics and consequence of complications during vaginal hysterectomy.Study design: Retrospectively study all the patients without uterine prolapse in whom hysterectomy with or without adnexectomy was indicated in the general hospital of PLA in the past eleven years. In our study excessive uterine size, nulliparity, history of pelvic surgery were not considered as contraindications, but concomitant procedures, the anterior and posterior repair, ureter support and excision of tumor were rejected. Operation time, blood loss, baseline characteristics, and complication were recorded. Retrospective analysis complications of 1270 hysterectomy during a ten-year period in General Hospital of PLA.Result: Of the 1779 cases considered, Before 1999 all the patients were first considered for the abdominal hysterectomy , but after 1999 the vaginal hysterectomy became the first choice for the patients. The rate of vaginal hysterectomy before1999 and after it was 2.1% and 87.4%, respectively. The highest vaginal hysterectomy rate was 94.5%, and it increased more than 90% at the fifth year. The operative time and estimated blood loss of vaginal hysterectomy was 47.5min and 179.4ml, respectively. The operative time and estimated blood loss of abdominal hysterectomy was 129.3min. 249.8ml, respectively. The vaginal hysterectomy complication rate were 10.2%. Fever rate were 3.5%, it was the most common in vaginal hysterectomy. Incidence of urinary and intestinal tract injuries were 0.47 and 0.15%, respectively.Concerning urinary tract injuries, we observed only one ureteral lesion, the others being bladder lacerations. The ureteral lesion occurred during suture, the bladder injuries occurred during the opening of the vesico-vaginal space and the rectal occurred during attempting to gain entry into the pouch of Douglas. Except for the ureteral lesion, all the other operation injuries were identified and repaired during the operation.Conclusion: Vaginal hysterectomy should be the primary route for the hysterectomy in the patients with benign disease and initial malignant tumor because of the minimal invasion. An average practicing gynecologist can increase his/her vaginal hysterectomy rate more than 90% within five years without increasing complication. Increasing the comfort level enabled by appropriate instrumentation should permit the less experienced surgeon an opportunity to expand the indications for vaginal hysterectomy, and in skilled hands vaginal hysterectomy may be performed even in difficult patients. The complications rate of vaginal hysterectomy is lower, operating injuries is rare and they are easily recognized and treated during the operation without important sequellae.