Analysis Of Clinical Efficacy And Risk About Morcellation Applied To Subtotal Hysterectomy

Objective:To evaluate the clinical efficacy of laparoscopic subtotal hysterectomy(LSH)and transabdominal subtotal hysterectomy(TSH).To investigate the incidence of parasitic myoma after morcellation and the ratio of morcellation applied to unexpected uterine malignant tumors and its influence on prognosis.Through these three aspects,to evaluate the feasibility of morcellation applied to laparoscopic subtotal hysterectomy.Methods: From september 2009 to December 2014,949 cases were selected,their main diagnosis was uterine myoma and their main operation method was laparoscopic subtotal hysterectomy(LSH)or transabdominal subtotal hysterectomy(TSH).They were divided into two groups,laparoscopic group(540 cases)and transabdominal group(409 cases).Patients who have minor surgery was excluded.According to the size of the uterus(12 weeks),remaining patients were divided into four groups.Small uterine laparoscopic group(349 cases),large uterine laparoscopic group(22 cases),small uterine transabdominal group(233 cases),large uterine transabdominal group(31 cases).The operative time,blood loss and postoperative hospitalized day were compared.The incidence of parasitic myoma was compared between laparoscopic group(540 cases)and transabdominal group(409 cases)after operation of 1 year,3 years and 5 years.Patients diagnosed of uterine malignant tumor by postoperative pathology were selected.The ratio of morcellation applied to unexpected uterine malignant tumors and its influence on prognosis was compared between two group.All data was analyzed with SPSS 17.0,P<0.05 was shown of difference.Results: Less blood loss and postoperative hospitalized day were found in small uterine laparoscopic group than small uterine transabdominal group.In terms of operative time,there was no significant difference between two groups.Less postoperative hospitalized day were found in large uterine laparoscopic group than large uterine transabdominal group.In terms of operative time and blood loss,there were no significant difference between two groups.All of patients were followed after operation of one year,three years and five years.And the follow-up rates were 81.45%(773/949),63.7%(428/672)and 46.2%(145/314).No parasitic myoma was found in both groups.The number of the patients diagnosed or highly suspected uterine malignant tumor by postoperative pathology was 6(0.63%).There were 3 cases(2 cases of endometrial stromal sarcoma,1 cases of leiomyosarcoma of uterus)of uterine malignant tumors in laparoscopic group.There were 3 cases(2 cases of endometrial stromal sarcoma,1 forendometrioid adenocarcinoma)of uterine malignant tumors in transabdominal group.There was no significant difference in the ratio between laparoscopic group and transabdominal group.One case accepted the second operation and chemotherapy for recurrence after 2 months,and died post operation of laparoscopic subtotal hysterectomy for 6 years.The rest of cases were without recurrence or death.Conclusions: Laparoscopy is safe to complete subtotal hysterectomy with reduced blood lose and quick convalescence,especially for patients who uterus size less than 12 weeks.The risk of parasitic myoma after laparoscopic subtotal hysterectomy is low.The probability of laparoscopic morcellation appliedto unexpected uterine malignant tumors is rare.Patients get benefit from the second surgery as soon as possible,contained power morcellation within an insufflated isolation bag and other improved surgical methods are in the exploratory stage.Morcellation applied to subtotal hysterectomy is still feasible.