title: [Clinical study of delivery method in modified vaginal hysterectomy for large uterus].
abstract: OBJECTIVE
  To prospectively explore the techniques, feasibility and safety of modified vaginal hysterectomy for large uterus.
  
  
  METHODS
  A total of 158 patients undergoing hysterectomy at Beijing Hospital from January 2008 to December 2010 were divided into three groups: 12-16 gestational weeks large uterus for vaginal hysterectomy (n = 65, group 1), 12-16 gestational weeks uterus for abdominal hysterectomy (n = 47, group 2) and <10 gestational weeks uterus for vaginal hysterectomy (n = 46, group 3). The pattern and techniques of delivery in group 1 was based on the location of fibroids/adenomyoma (in anterior wall, posterior wall, uterine horn or broad ligament, cervix) and the direction of overall shape maximum diameter (direction towards abdomen defined as long type while the direction towards lateral pelvic wall wide type). The completion and safety were observed intraoperatively. The outpatient follow-up period was 1 month.
  
  
  RESULTS
  A total of 158 cases of hysterectomy were performed successfully. The locations of fibroids/adenomyoma included anterior wall (n = 17), posterior wall (n = 24), unilateral uterine horn (n = 6), broad ligament (n = 3) and cervix (n = 2). in group 1, and there were long (n = 6) and wide (n = 7) types. They were all successfully delivered through vagina through various techniques. No case was converted into laparotomy. The average largest size (judged by as large as number of gestational weeks) and weight of uterus was group 2 and followed by group 1. But the difference of size and weight between two groups was insignificant (P > 0.05). Sorted by mean operative duration, mean amount of bleeding and decrease of hemoglobin, the declining order was the group 2, group 1 and group 3. The amount of bleeding for group 1 was less than that for group 2 (P < 0.05). But it was more than group 3 (P > 0.05). According to postoperative hospitalization duration, flatus time and indwelling catheter time, no statistical differences existed between groups 1 and 3. But the values of group 1 were significantly better than those of group 2 (P < 0.01, <0.05, <0.01).
  
  
  CONCLUSIONS
  Vaginal hysterectomy is a safe and effective option for removing enlarged uterus. This pattern of operation can reduce the postoperative hospitalization time, flatus time and indwelling catheter time.
authors.affiliation: Department of Obstetrics & Gynecology, Beijing Hospital, Beijing 100730, China. Email: dengwenhui@hotmail.com.
authors.forename: Wen-hui
authors.initials: WH
authors.lastname: Deng
authors.affiliation: Department of Obstetrics & Gynecology, Beijing Hospital, Beijing 100730, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Obstetrics & Gynecology, Beijing Hospital, Beijing 100730, China.
authors.forename: Qiu-bo
authors.initials: QB
authors.lastname: Lü
authors.affiliation: Department of Obstetrics & Gynecology, Beijing Hospital, Beijing 100730, China.
authors.forename: Feng-hua
authors.initials: FH
authors.lastname: Wei
authors.affiliation: Department of Obstetrics & Gynecology, Beijing Hospital, Beijing 100730, China.
authors.forename: Qing-wei
authors.initials: QW
authors.lastname: Meng
authors.affiliation: Department of Obstetrics & Gynecology, Beijing Hospital, Beijing 100730, China.
authors.forename: Gui-hua
authors.initials: GH
authors.lastname: Shen
authors.affiliation: Department of Obstetrics & Gynecology, Beijing Hospital, Beijing 100730, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Lei
mesh_terms: D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods*; D009929:Organ Size; D011446:Prospective Studies; D014591:Uterine Diseases / Q000601:surgery*; D014599:Uterus