Volkan KARATAŞLI, Adnan BUDAK, Abdurrahman Hamdi İNAN

UTERİN PROLAPSUS NEDENİ İLE YAPILAN VAJİNAL HİSTEREKTOMİLERİN ERKEN VE GEÇ DÖNEM KOMPLİKASYONLARI

Giriş: Pelvik organ prolapsusu, ortalama yaşam süresinin artması ile beraber sıklığı artan, kadınların yaşam kalitesi ve cinsel fonksiyonlarını etkileyen bir durumdur. Son yıllarda medikal ve minimal invaziv yöntemlerin kullanımının artmasıyla beraber uygulanmasında azalma olmasına rağmen semptomatik uterin prolapsus için uygulanan etkin ve güvenli cerrahi yöntemlerin başlarında vajinal histerektomi gelmektedir. Ancak vajinal histerektomi sonrası bazı komplikasyonlar görülebilmektedir. Bu çalışmada kliniğimizde uterin prolapsus nedeni ile vajinal histerektomi yapılmış hastaların özellikleri, operasyon sonuçları, erken ve geç dönemde gerçekleşen komplikasyonların belirlenmesi amaçlanmıştır. Gereç ve Yöntem: Ocak 2010 – Aralık 2015 arasında Sağlık Bilimleri Üniversitesi Tepecik Eğitim ve Araştırma Hastanesi’nde semptomatik uterin prolapsus nedeni ile; fertilite beklentisi olmayan, cerrahiye engel komorditeleri bulunmayan, konservatif yöntemlerle tedavi edilemeyen, daha önce ürojinekolojik operasyon geçmişi olmayan, vajinal histerektomi yapılmış hastalar çalışmaya dahil edildi. Operasyon bulguları, intraoperatif ve postopertif komplikasyonları incelendi. Bulgular: Bu çalışmada uterin prolapsus nedeni ile vajinal histerektomi yapılmış 392 hasta incelendi. Hastaların yaş ortalamaları 61,2±9,3 idi, median parite değeri 3 olarak bulundu (minimum 0 -maksimum12).Hastaların %83,9’unda vajinal histerektomi ve kolporafi anterior/posterior yapıldığı saptandı. Ortalama operasyon süresi 118 ±33,4dk iken, ortalama uterin ağırlık 53 g (aralık 26-279) idi. Hastane kalış süresi ortalaması ise 5±2,9 gün olarak hesaplandı. Hastaların %2,3‘üne kan transfüzyonu yapıldığı belirlendi. Vajinal histerektomi sonrası görülen toplam komplikasyon oranı %17 idi. İdrar yolu enfeksiyonu hastaların %2’sinde görüldü. En sık görülen görülen intraoperatif komplikasyon mesane yaralanması (%1,3) iken, hastaların %4,6’sında postoperatif ortalama 16 ayda vajinal kaf prolapsusu geliştiği saptandı. En sık idrar yapamama nedeni ile olmak üzere operasyon sonrası rehospitalizasyon oranı %1,2 idi. Operasyona bağlı yaşamı tehdit edici olay ve mortalite saptanmadı. Sonuç: Son yıllarda uygulanmasındaki azalmaya rağmen, semptomatik uterin prolapsusu olan hastalarda en uygun cerrahi yöntemlerden biri, kabul edilebilir komplikasyon oranları ile vajinal histerektomidir.

EARLY AND LATE COMPLICATIONS OF VAGINAL HYSTERECTOMY FOR UTERINE PROLAPSE

Introduction: Pelvic organ prolapse is a problem affecting womens quality of life and sexual functions and the incidence increases with increasing average life expectancy. Although less applied in recent years, with the increasing use of medical and minimally invasive methods, vaginal hysterectomy is an effective and safe method for treatment of symptomatic uterine prolapse. However, some complications can be seen. The aim of the study is to determine the characteristics of the patients who underwent vaginal hysterectomy for uterine prolapse, the results of the operations, and the early and late complications of surgery. Material and Methods: The patients who were treated with vaginal hysterectomy for uterine prolapse between January 2010 and December 2015 in University of Healh Sciences Tepecik Training and Research Hospital were investigated. Patients with no fertility expectancy, no operative obstacles, who can’t be treated with conservative methods, and no previous history of urogynecologic surgery were included. Operation results, intraoperative and postoperative complications were analysed. Results: In this study, 392 patients operated with vaginal hysterectomy were examined. The mean age was 61,2±9,3 and median parity was 3 (min 0-max 12). 83.9% of the patients were treated with vaginal hysterectomy and colporrhaphy anterior/posterior. The mean operation time was 118 ± 33.4 min, while the mean uterine weight was 53 g (range 26-279).The mean hospital stay was calculated as 5 ± 2.9 days. Blood transfusion was administered in 2.3% of the patients. The total complication rate after vaginal hysterectomy was 17%. Urinary tract infection occurred in 2% of the patients. The most common intraoperative complication was bladder injury (1.3%) and vaginal vault prolapse occurred in 4,6% of the patients at median16.months postoperatively.The rate of re-hospitalization was 1.2% and the most common reason was urinary retention. There were no life-threatening events and mortality related to the operation. Conclusion: Although less applied in recent years, one of the most suitable surgical methods in patients with symptomatic uterine prolapse is vaginal hysterectomy with admissible complication rates.

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