Abdominal, vajinal ve total laparoskopik histerektominin maliyet etkinliklerinin ve klinik sonuçlarının seçili hasta grubunda karşılaştırılması
Öz
Amaç: Total laparoskopik
histerektomi (TLH), total abdominal histerektomi (TAH) ve vajinal
histerektominin (VH) perioperatif ve postoperatif sonuçlarını; seçili hasta
grubunda karşılaştırmaktır.
Gereç ve Yöntem: 223 histerektomi
çalışmaya dahil edildi. Hastalar üç gruba ayrıldı. Grup 1'de TLH (n = 63); Grup
2'de TAH (n = 133), Grup 3 ise VH (n = 37) yapılan hastalardan oluşuyordu. Her
üç grubun da benzer yaş, parite ve uterus boyutları vardı. Başlıca
değerlendirilen ölçütler; ameliyat süresi, ateş, analjezi gereksinimi, hastanede
kalış süresi, işe geri dönüş süresi, perioperatif ve postoperatif
komplikasyonlar, kan transfüzyonu sayısı ve ameliyat masrafları idi.
Bulgular: Operasyon süresi
VH grubunda en kısa idi. Üç grup arasında hastanede kalış süreleri açısından
anlamlı farklılık saptanmadı. VH en ucuz histerektomi tipiydi. VH grubu TLH
grubuyla karşılaştırıldığında; analjezik gereksinimi ve işe geri dönüş süresi
açısından istatistiki fark tespit edilmedi. VH grubunda; TAH (p = 0.001) ve TLH
gruplarına kıyasla daha fazla kan transfüzyonu gerektiği saptandı(p <0.001).
Sonuç: VH diğer iki
teknik ile karşılaştırıldığında en kısa operasyon süresi ve en düşük cerrahi
maliyete sahipken; benzer perioperatif ve postoperatif sonuçlar saptandı.
Anahtar Kelimeler
laparoskopik histerektomi abdominal histerektomi vajinal histerektomi maliyet etkinlik
Kaynakça
- 1. Whiteman MK, Hillis SD, Jamieson DJ, Morrow B, Podgornik MN, Brett KM, et al. Inpatient hysterectomy surveillance in the United States, 2000-2004. American Journal of Obstetrics and Gynecology 2008; 198: 34.e1-.e7. doi: 10.1016/j.ajog.2007.05.039
- 2. Wu JM, Wechter ME, Geller EJ, Nguyen TV, Visco AG. Hysterectomy Rates in the United States, 2003. Obstetrics & Gynecology 2007; 110: 1091-5. doi: 10.1097/01.AOG.0000285997.38553.4b
- 3. Reich H, DeCaprio J, McGlynn F. Laparoscopic Hysterectomy. Journal of Gynecologic Surgery 1989; 5: 213-6. doi: 10.1089/gyn.1989.5.213
- 4. BRILL AI. Hysterectomy in the 21st Century: Different Approaches, Different Challenges. Clinical Obstetrics and Gynecology 2006; 49: 722-35. doi: 10.1097/01.grf.0000211946.51712.42
- 5. Clayton RD. Hysterectomy. Best practice & research Clinical obstetrics & gynaecology 2006; 20: 73-87. doi: 10.1016/j.bpobgyn.2005.09.007
- 6. Nieboer TE, Johnson N, Barlow D, Lethaby A, Tavender E, Curr E, et al. Surgical approach to hysterectomy for benign gynaecological disease. In: Kluivers K, editor. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2006. p. CD003677.
- 7. Johnson N, Barlow D, Lethaby A, Tavender E, Curr L, Garry R. Methods of hysterectomy: systematic review and meta-analysis of randomised controlled trials. BMJ (Clinical research ed) 2005; 330: 1478. doi: 10.1136/bmj.330.7506.1478 8. Garry R, Fountain J, Mason S, Hawe J, Napp V, Abbott J, et al. The eVALuate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy. BMJ (Clinical research ed) 2004; 328: 129. doi: 10.1136/bmj.37984.623889.F6 9. Soriano D, Goldstein A, Lecuru F, Daraï E. Recovery from vaginal hysterectomy compared with laparoscopy-assisted vaginal hysterectomy: a prospective, randomized, multicenter study. Acta obstetricia et gynecologica Scandinavica 2001; 80: 337-41.
- 10. Daraï E, Soriano D, Kimata P, Laplace C, Lecuru F. Vaginal hysterectomy for enlarged uteri, with or without laparoscopic assistance: randomized study. Obstetrics and gynecology 2001; 97: 712-6.
- 11. Ribeiro SC, Ribeiro RM, Santos NC, Pinotti JA. A randomized study of total abdominal, vaginal and laparoscopic hysterectomy. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2003; 83: 37-43.
- 12. Summitt RL, Stovall TG, Lipscomb GH, Ling FW. Randomized comparison of laparoscopy-assisted vaginal hysterectomy with standard vaginal hysterectomy in an outpatient setting. Obstetrics and gynecology 1992; 80: 895-901.
- 13. Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R, et al. Surgical approach to hysterectomy for benign gynaecological disease. The Cochrane database of systematic reviews 2009: CD003677. doi: 10.1002/14651858.CD003677.pub4 14. Allam IS, Makled AK, Gomaa IA, El Bishry GM, Bayoumy HA, Ali DF. Total laparoscopic hysterectomy, vaginal hysterectomy and total abdominal hysterectomy using electrosurgical bipolar vessel sealing technique: a randomized controlled trial. Archives of gynecology and obstetrics 2015; 291: 1341-5. doi: 10.1007/s00404-014-3571-3
- 15. Hwang J-L, Seow K-M, Tsai Y-L, Huang L-W, Hsieh B-C, Lee C. Comparative study of vaginal, laparoscopically assisted vaginal and abdominal hysterectomies for uterine myoma larger than 6 cm in diameter or uterus weighing at least 450 g: a prospective randomized study. Acta obstetricia et gynecologica Scandinavica 2002; 81: 1132-8.
- 16. Ottosen C, Lingman G, Ottosen L. Three methods for hysterectomy: a randomised, prospective study of short term outcome. BJOG : an international journal of obstetrics and gynaecology 2000; 107: 1380-5.
- 17. Sesti F, Cosi V, Calonzi F, Ruggeri V, Pietropolli A, Di Francesco L, et al. Randomized comparison of total laparoscopic, laparoscopically assisted vaginal and vaginal hysterectomies for myomatous uteri. Archives of gynecology and obstetrics 2014; 290: 485-91. doi: 10.1007/s00404-014-3228-2
- 18. Sesti F, Calonzi F, Ruggeri V, Pietropolli A, Piccione E. A comparison of vaginal, laparoscopic-assisted vaginal, and minilaparotomy hysterectomies for enlarged myomatous uteri. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2008; 103: 227-31. doi: 10.1016/j.ijgo.2008.07.006
- 19. Mäkinen J, Johansson J, Tomás C, Tomás E, Heinonen PK, Laatikainen T, et al. Morbidity of 10 110 hysterectomies by type of approach. Human reproduction (Oxford, England) 2001; 16: 1473-8. 20. Donnez O, Jadoul P, Squifflet J, Donnez J. A series of 3190 laparoscopic hysterectomies for benign disease from 1990 to 2006: evaluation of complications compared with vaginal and abdominal procedures. BJOG : an international journal of obstetrics and gynaecology 2009; 116: 492-500. doi: 10.1111/j.1471-0528.2008.01966.x
- 21. Walsh CA, Walsh SR, Tang TY, Slack M. Total abdominal hysterectomy versus total laparoscopic hysterectomy for benign disease: A meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology 2009; 144: 3-7. doi: 10.1016/j.ejogrb.2009.01.003
- 22. Young W, Cohen MM. Laparoscopically assisted vaginal hysterectomy. A review of current issues. International journal of technology assessment in health care 1997; 13: 368-79.
- 23. Doğanay M, Yildiz Y, Tonguc E, Var T, Karayalcin R, Eryılmaz OG, et al. Abdominal, vaginal and total laparoscopic hysterectomy: perioperative morbidity. Archives of gynecology and obstetrics 2011; 284: 385-9. doi: 10.1007/s00404-010-1678-8
- 24. Drahonovsky J, Haakova L, Otcenasek M, Krofta L, Kucera E, Feyereisl J. A prospective randomized comparison of vaginal hysterectomy, laparoscopically assisted vaginal hysterectomy, and total laparoscopic hysterectomy in women with benign uterine disease. European Journal of Obstetrics & Gynecology and Reproductive Biology 2010; 148: 172-6. doi: 10.1016/j.ejogrb.2009.10.019
- 25. Lenihan JP, Kovanda C, Cammarano C. Comparison of laparoscopic-assisted vaginal hysterectomy with traditional hysterectomy for cost-effectiveness to employers. American journal of obstetrics and gynecology 2004; 190: 1714-20; discussion 20-2. doi: 10.1016/j.ajog.2004.02.059
Comparison of cost-effectivenes and clinical outcomes of abdominal, vaginal and total laparoscopic hysterectomy in a selected group
Öz
Objective: The aim was to compare
the perioperative and postoperative outcomes of total laparoscopic hysterectomy(TLH),
total abdominal hysterectomy(TAH), and vaginal hysterectomy(VH) in a selected group
of patients.
Materials and Methods:
Two hundred twenty-three hysterectomies were included in this
study. The patients were separated into three groups. Group1 included patients with
TLH(n=63); TAH patients were placed in Group 2(n=133), and Group 3 was made up of
patients who underwent VH(n=37). All three groups had similar ages, parities, and
uterine sizes. The main outcome measures were operation time, fever, need for analgesia,
duration of hospital survellience, return to work time, perioperative and postoperative
complications, the number of blood transfusions, and costs of the surgery.
Results: The total operation
time was the shortest in the VH group. There was no significant difference in the
hospital survellience duration between the three groups. The VH was found to be
the cheapest type of hysterectomy. When the VH group was compared with the TLH group,
there was no difference in the use of analgesics for postoperative pain or the
time return to work. The VH group patients required more blood transfusions in
contrast with the TAH(p=0.001) and TLH
groups(p<0.001).
Conclusion: VH had similar operative
and postoperative outcomes but the shortest duration of operation and the lowest
surgical cost compared with the other two techniques.
Anahtar Kelimeler
total laparoscopic hysterectomy total abdominal hysterectomy vaginal hysterectomy cost-effectiveness
Kaynakça
- 1. Whiteman MK, Hillis SD, Jamieson DJ, Morrow B, Podgornik MN, Brett KM, et al. Inpatient hysterectomy surveillance in the United States, 2000-2004. American Journal of Obstetrics and Gynecology 2008; 198: 34.e1-.e7. doi: 10.1016/j.ajog.2007.05.039
- 2. Wu JM, Wechter ME, Geller EJ, Nguyen TV, Visco AG. Hysterectomy Rates in the United States, 2003. Obstetrics & Gynecology 2007; 110: 1091-5. doi: 10.1097/01.AOG.0000285997.38553.4b
- 3. Reich H, DeCaprio J, McGlynn F. Laparoscopic Hysterectomy. Journal of Gynecologic Surgery 1989; 5: 213-6. doi: 10.1089/gyn.1989.5.213
- 4. BRILL AI. Hysterectomy in the 21st Century: Different Approaches, Different Challenges. Clinical Obstetrics and Gynecology 2006; 49: 722-35. doi: 10.1097/01.grf.0000211946.51712.42
- 5. Clayton RD. Hysterectomy. Best practice & research Clinical obstetrics & gynaecology 2006; 20: 73-87. doi: 10.1016/j.bpobgyn.2005.09.007
- 6. Nieboer TE, Johnson N, Barlow D, Lethaby A, Tavender E, Curr E, et al. Surgical approach to hysterectomy for benign gynaecological disease. In: Kluivers K, editor. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2006. p. CD003677.
- 7. Johnson N, Barlow D, Lethaby A, Tavender E, Curr L, Garry R. Methods of hysterectomy: systematic review and meta-analysis of randomised controlled trials. BMJ (Clinical research ed) 2005; 330: 1478. doi: 10.1136/bmj.330.7506.1478 8. Garry R, Fountain J, Mason S, Hawe J, Napp V, Abbott J, et al. The eVALuate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy. BMJ (Clinical research ed) 2004; 328: 129. doi: 10.1136/bmj.37984.623889.F6 9. Soriano D, Goldstein A, Lecuru F, Daraï E. Recovery from vaginal hysterectomy compared with laparoscopy-assisted vaginal hysterectomy: a prospective, randomized, multicenter study. Acta obstetricia et gynecologica Scandinavica 2001; 80: 337-41.
- 10. Daraï E, Soriano D, Kimata P, Laplace C, Lecuru F. Vaginal hysterectomy for enlarged uteri, with or without laparoscopic assistance: randomized study. Obstetrics and gynecology 2001; 97: 712-6.
- 11. Ribeiro SC, Ribeiro RM, Santos NC, Pinotti JA. A randomized study of total abdominal, vaginal and laparoscopic hysterectomy. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2003; 83: 37-43.
- 12. Summitt RL, Stovall TG, Lipscomb GH, Ling FW. Randomized comparison of laparoscopy-assisted vaginal hysterectomy with standard vaginal hysterectomy in an outpatient setting. Obstetrics and gynecology 1992; 80: 895-901.
- 13. Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R, et al. Surgical approach to hysterectomy for benign gynaecological disease. The Cochrane database of systematic reviews 2009: CD003677. doi: 10.1002/14651858.CD003677.pub4 14. Allam IS, Makled AK, Gomaa IA, El Bishry GM, Bayoumy HA, Ali DF. Total laparoscopic hysterectomy, vaginal hysterectomy and total abdominal hysterectomy using electrosurgical bipolar vessel sealing technique: a randomized controlled trial. Archives of gynecology and obstetrics 2015; 291: 1341-5. doi: 10.1007/s00404-014-3571-3
- 15. Hwang J-L, Seow K-M, Tsai Y-L, Huang L-W, Hsieh B-C, Lee C. Comparative study of vaginal, laparoscopically assisted vaginal and abdominal hysterectomies for uterine myoma larger than 6 cm in diameter or uterus weighing at least 450 g: a prospective randomized study. Acta obstetricia et gynecologica Scandinavica 2002; 81: 1132-8.
- 16. Ottosen C, Lingman G, Ottosen L. Three methods for hysterectomy: a randomised, prospective study of short term outcome. BJOG : an international journal of obstetrics and gynaecology 2000; 107: 1380-5.
- 17. Sesti F, Cosi V, Calonzi F, Ruggeri V, Pietropolli A, Di Francesco L, et al. Randomized comparison of total laparoscopic, laparoscopically assisted vaginal and vaginal hysterectomies for myomatous uteri. Archives of gynecology and obstetrics 2014; 290: 485-91. doi: 10.1007/s00404-014-3228-2
- 18. Sesti F, Calonzi F, Ruggeri V, Pietropolli A, Piccione E. A comparison of vaginal, laparoscopic-assisted vaginal, and minilaparotomy hysterectomies for enlarged myomatous uteri. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2008; 103: 227-31. doi: 10.1016/j.ijgo.2008.07.006
- 19. Mäkinen J, Johansson J, Tomás C, Tomás E, Heinonen PK, Laatikainen T, et al. Morbidity of 10 110 hysterectomies by type of approach. Human reproduction (Oxford, England) 2001; 16: 1473-8. 20. Donnez O, Jadoul P, Squifflet J, Donnez J. A series of 3190 laparoscopic hysterectomies for benign disease from 1990 to 2006: evaluation of complications compared with vaginal and abdominal procedures. BJOG : an international journal of obstetrics and gynaecology 2009; 116: 492-500. doi: 10.1111/j.1471-0528.2008.01966.x
- 21. Walsh CA, Walsh SR, Tang TY, Slack M. Total abdominal hysterectomy versus total laparoscopic hysterectomy for benign disease: A meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology 2009; 144: 3-7. doi: 10.1016/j.ejogrb.2009.01.003
- 22. Young W, Cohen MM. Laparoscopically assisted vaginal hysterectomy. A review of current issues. International journal of technology assessment in health care 1997; 13: 368-79.
- 23. Doğanay M, Yildiz Y, Tonguc E, Var T, Karayalcin R, Eryılmaz OG, et al. Abdominal, vaginal and total laparoscopic hysterectomy: perioperative morbidity. Archives of gynecology and obstetrics 2011; 284: 385-9. doi: 10.1007/s00404-010-1678-8
- 24. Drahonovsky J, Haakova L, Otcenasek M, Krofta L, Kucera E, Feyereisl J. A prospective randomized comparison of vaginal hysterectomy, laparoscopically assisted vaginal hysterectomy, and total laparoscopic hysterectomy in women with benign uterine disease. European Journal of Obstetrics & Gynecology and Reproductive Biology 2010; 148: 172-6. doi: 10.1016/j.ejogrb.2009.10.019
- 25. Lenihan JP, Kovanda C, Cammarano C. Comparison of laparoscopic-assisted vaginal hysterectomy with traditional hysterectomy for cost-effectiveness to employers. American journal of obstetrics and gynecology 2004; 190: 1714-20; discussion 20-2. doi: 10.1016/j.ajog.2004.02.059
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Orjinal Araştırma |
| Yazarlar | |
| Yayımlanma Tarihi | 5 Mart 2018 |
| Yayımlandığı Sayı | Yıl 2018 Cilt: 49 Sayı: 1 |
