Approximately one million hysterectomies are performed each year in China. However, national data regarding the indications and the surgical approaches for hysterectomy are lacking. The aim of this study was to examin...Approximately one million hysterectomies are performed each year in China. However, national data regarding the indications and the surgical approaches for hysterectomy are lacking. The aim of this study was to examine the surgical indications for hysterectomy in different age groups and the relative merits of different surgical approaches for hysterectomy in Chinese women. Clinical data from 4653 cases of hysterectomy performed in Tongji Hospital from 2004 to 2009 were analysed. Hysterectomy was most commonly performed among women aged 40-49 years （2299; 49.4%）. Overall, colporrhagia and abdominal pain were the two most common indications for hysterectomy. The most common indications by age groups were as follows： malignant ovarian tumour, 〈 20 years; malignant uterine tumour, 20-29 and 30-39 years; uterine myoma, 40-49 and 50-59 years; and uterine prolapse, 60-69 and 〉 70 years. The proportion of malignant aetiology also varied by age, being the highest in women aged 〈 20 years （75.0%） and the lowest in those aged 40-49 years （19.9%）. Approximately 35% women who had hysterectomies also had concomitant bilateral oophorectomy. The lowest rate of oophorectomy occurred in women aged 30-39years （15.8%）, whereas the highest rate was in those aged 50-59years （75.9%）. The abdominal surgical approach was used in 84% of all hysterectomies. Surgeries using the vaginal approach required a significantly shorter operating time （118 min average） than all other approaches （P 〈 0.05）. Both the amount of bleeding and the blood transfusion volume required were smaller in vaginal approaches, with no significant differences between the others. The surgical approaches used were also related to the scope of surgery. Both the surgical indications and the rates of bilateral oophorectomy varied by age. In terms of both operating time and the amount of bleeding and blood transfusion volume required, the vaginal approach was superior to all other surgical approaches.展开更多
Numerous surgical modalities are available to treat adrenal lesions. Minimally-invasive approaches for adrenalectomy are indicated in most circumstances, and new evidence continues to be accumulated. In this context, ...Numerous surgical modalities are available to treat adrenal lesions. Minimally-invasive approaches for adrenalectomy are indicated in most circumstances, and new evidence continues to be accumulated. In this context, current indications for open surgical adrenalectomy(OS-A), minimally-invasive adrenalectomy(MI-A), and laparoendoscopic single-site adrenalectomy(LESS-A) remain unclear. A comprehensive Englishlanguage literature review was performed using MEDLINE/Pub MED to identify articles and guidelines pertinent to the surgical management of adrenal tumors. A comprehensive chart review was performed for three illustrative cases. Clinical recommendations were generated based on relevant literature and the expertise of the investigator group. MI-A offers advantages over OS-A in properly selected patients, who experience fewer complications, lower blood loss, and shorter hospital stays. Robot-assisted laparoscopic and retroperitoneoscopic adrenalectomy may offer advantages over transperitoneal surgery, and LESS-A may be an even less-invasive option that will require further evaluation. MI-A remains the surgical treatment of choice for most adrenal lesions. Tumor size and stage are the primary indications for selecting alternative treatment modalities. OS-A remains the gold standard for large tumors(> 10 cm) and suspected or known advanced stage malignancy. LESS-A appears to be an appropriate initial approach for small tumors(< 4-5 cm), including pheochromocytoma and isolated adrenal metastases.展开更多
文摘Approximately one million hysterectomies are performed each year in China. However, national data regarding the indications and the surgical approaches for hysterectomy are lacking. The aim of this study was to examine the surgical indications for hysterectomy in different age groups and the relative merits of different surgical approaches for hysterectomy in Chinese women. Clinical data from 4653 cases of hysterectomy performed in Tongji Hospital from 2004 to 2009 were analysed. Hysterectomy was most commonly performed among women aged 40-49 years （2299; 49.4%）. Overall, colporrhagia and abdominal pain were the two most common indications for hysterectomy. The most common indications by age groups were as follows： malignant ovarian tumour, 〈 20 years; malignant uterine tumour, 20-29 and 30-39 years; uterine myoma, 40-49 and 50-59 years; and uterine prolapse, 60-69 and 〉 70 years. The proportion of malignant aetiology also varied by age, being the highest in women aged 〈 20 years （75.0%） and the lowest in those aged 40-49 years （19.9%）. Approximately 35% women who had hysterectomies also had concomitant bilateral oophorectomy. The lowest rate of oophorectomy occurred in women aged 30-39years （15.8%）, whereas the highest rate was in those aged 50-59years （75.9%）. The abdominal surgical approach was used in 84% of all hysterectomies. Surgeries using the vaginal approach required a significantly shorter operating time （118 min average） than all other approaches （P 〈 0.05）. Both the amount of bleeding and the blood transfusion volume required were smaller in vaginal approaches, with no significant differences between the others. The surgical approaches used were also related to the scope of surgery. Both the surgical indications and the rates of bilateral oophorectomy varied by age. In terms of both operating time and the amount of bleeding and blood transfusion volume required, the vaginal approach was superior to all other surgical approaches.
文摘Numerous surgical modalities are available to treat adrenal lesions. Minimally-invasive approaches for adrenalectomy are indicated in most circumstances, and new evidence continues to be accumulated. In this context, current indications for open surgical adrenalectomy(OS-A), minimally-invasive adrenalectomy(MI-A), and laparoendoscopic single-site adrenalectomy(LESS-A) remain unclear. A comprehensive Englishlanguage literature review was performed using MEDLINE/Pub MED to identify articles and guidelines pertinent to the surgical management of adrenal tumors. A comprehensive chart review was performed for three illustrative cases. Clinical recommendations were generated based on relevant literature and the expertise of the investigator group. MI-A offers advantages over OS-A in properly selected patients, who experience fewer complications, lower blood loss, and shorter hospital stays. Robot-assisted laparoscopic and retroperitoneoscopic adrenalectomy may offer advantages over transperitoneal surgery, and LESS-A may be an even less-invasive option that will require further evaluation. MI-A remains the surgical treatment of choice for most adrenal lesions. Tumor size and stage are the primary indications for selecting alternative treatment modalities. OS-A remains the gold standard for large tumors(> 10 cm) and suspected or known advanced stage malignancy. LESS-A appears to be an appropriate initial approach for small tumors(< 4-5 cm), including pheochromocytoma and isolated adrenal metastases.
