The Feasibility Analysis Of Laparoscopic Hysterectomy In Uremia Patients

ObjectiveTo explore the feasibility of laparoscopic hysterectomy and perioperative management in uremia patients with abnormal uterine bleeding.MethodsWe retrospectively analyze 4 cases of uremia patients with abnormal uterine bleeding, who were treated in the department of Gynecology of the Shandong Qianfoshan Hospital affiliated to Shandong University from Sept.2013 to May 2015. Combined with literature data, we discussed the feasibility of laparoscopic hysterectomy and perioperative management for those patients without fertility requirements.ResultsFour cases of uremic patients with abnormal uterine bleeding were successfully performed with laparoscopic hysterectomy. The average operation time:124 min; The average intraoperative blood loss:32.5 ml; The average intraoperative infusion quantity:750 ml crystalloid solution; The intraoperative urinary volume:three of the patients with preoperative had failed renal, no urine,1 case of patients, namely cases (2), with intraoperative urinary volume of about 100 ml; The last preoperative dialysis before starting operation:1-2 days; The start dialysis time postoperatively: 1-2 days; The disposition where the postoperative patients to:Case (1) discharged from hospital 8 days after operation; Case (2) transferred to Uropoiesis surgical department 4 days after operation waiting for kidney; Cases (3) and Case (4) transferred to Nephrology department 1 day after operation. The pathologies of these four patients were endometrial cancer, endometrial atypical hyperplasia, high grade cervical intraepithelial neoplasia and uterine fibroids respectively. They were all in the regular follow-up after operation, and now are all generally in good condition. One of them received kidney transplant operation 3 months after surgery, and now receiving oral anti-rejection drugs with urology clinic visits on a regular basis; the other three were in routine periodic blood dialysis treatment. One case, whose pathology was endometrial carcinoma, underwent adjuvant radiotherapy 1 month after surgery, and now is in regular physical and blood examination for more than 2 years, with no evidence of recurrence.Conclusions1. Hysterectomy can be considered for uremia patients with abnormal uterine bleeding who don’t have fertility requirements.2. Through strengthening the perioperative management, it is safe and feasible to perform laparoscopic hysterectomy on uremia patients with abnormal uremia bleeding if equipment and surgical technique permitted.