자궁탈출증이외의 적응증에 대한 질식전자궁적출술의 임상적 고찰

Objective : To analyse the clinical aspects of total vaginal hysterectomy, we evaluated age distribution, parity, previous abdominal operations, indications for hysterectomy, postoperative pathology, combined operations, operation time, bleeding amount, hemoglobin change, weight of uterus, and postoperative complications. Methods : We reviewed the medical records of the 50 patients who underwent total vaginal hysterectomy for the indications other than uterine prolapse from July 1998 to June 1999 at chunchon Sacral Heart Hospital, Hallym University. Results : 1. Age distribution was from 31 to 55 years old and 78% of patients were in 36 to 45 years old group. 2. The most common parity was para 2 (56%) and the next was para 3 (30%). 3. The most common previous abdominal operation was laparoscopic tubal sterilization and followed by appendectomy, cesarean section, and pelvic operation. 4. The most common indication for vaginal hysterectomy was uterine myoma (74%) and followed by cervical intraepithelial neoplasia, atypical endometrial hyperplasia, and dysfunctional uterine bleeding. 5. The most common postoperative pathologic finding was uterine myoma (56%) and followed by adenomyosis, cervical intraepithelial neoplasia, endometrial hyperplasia, endometrial polyp, endometriosis, microinvasive cervical cancer, and endometrial cancer. 6. The concurrent surgical procedures were ovarian cystectomy (6%), parovarian cystectomy (6%), salpingo-oophrectomy (6%), and anterior or posterior vaginal colporrhapy (10%). 7. The operative time was within 2 hour in almost all cases (98%). 8. The bleeding amount was within 500 cc in almost all cases (98%). 9. The hemoglobin change was within 3 g/dl in almost all cases (98%). 10. The weight of hysterectomized specimen was over 300gm in 32% of patients. 11. There were 5 cases (10%) of vaginal cuff hematoma with infection, 3 cases (6%) of upper respiratory infection, and 2 cases (4%) of bladder dysfunction as the postoperative complications. Conclusion : Total vaginal hysterectomy is a safe method for removing uterus even in the absence of prolapse. Recently it's indication is widening to the patient who has larger uterus and history of previous pelvic surgery. Because of it's advantage, total vaginal hysterectomy would be the preferred method of hysterectomy in the future.