腹腔鏡、經陰道及腹壁子宮切除術於良性病變之術後疼痛：全國人口之比較

Postoperative pain after laparoscopic, vaginal and abdominal hysterectomy for benign pathology: a nationwide population-based comparison

子宮切除術是婦科常施行的手術之一。雖然腹腔鏡子宮切除術需要較長的手術時間，但其支持者強調在多方面均勝於腹壁子宮切除術：術中失血量、術後併發症少、恢復時間快、縮短住院時間、減少發燒、及早日恢復正常活動。在過去的十年中，只有很少的隨機試驗以術後疼痛作為主要效果來比較不同術式的差異。在當前的研究中，我們利用台灣全民健康保險資料庫，取樣2002年至2008年接受腹腔鏡子宮切除術、經陰道子宮切除術和腹壁子宮切除術的患者。在9659例子宮切除術中，腹腔鏡子宮切除術佔19.6%，腹壁子宮切除術佔58.8%，經陰道子宮切除佔21.7%；進而利用單因素和多因素邏輯回歸分析來分析術後疼痛、子宮切除術的類型和術後病理診斷之間的關聯性。我們的研究發現相對於腹壁及經陰道子宮切除術，腹腔鏡子宮切除術導致較少的術後疼痛，並縮短了患者的住院時間。

Hysterectomy is a commonly performed gynecological procedure. Although laparoscopic hysterectomy takes longer time, its proponents have emphasized several advantages over abdominal hysterectomy in terms of intraoperative blood loss, less postoperative morbidity, rapid recovery time, shorter hospital stay, fewer febrile episodes and early return to normal activities. In the past decade, only few randomized trials have compared these different approaches focusing on postoperative pain as the primary outcome. In the current study, we identified patients undergoing laparoscopic hysterectomy, vaginal hysterectomy and abdominal hysterectomy in 2002-2008 by sampling Taiwan's National Health Insurance (NHT) database. Among 9,659 hysterectomies, 19.6% were laparoscopic, 58.8% abdominal, and 21.7% vaginal. Univariate and multiple logistic regressions were used to analyze the association between postoperative pain, hysterectomy types and pathological diagnoses. Our study demonstrated that laparoscopic hysterectomy resulted in less postoperative pain and a shorter hospital stay, in comparison with abdominal and vaginal hysterectomy.