Субтотальная гистерэктомия с глубоким иссечением слизистой шейки матки как альтернатива тотальной гистерэктомии. За и против

Abstract

Objective. A comparative analysis of the immediate and long-term outcomes of total and subtotal hysterectomy with excision of the mucosal and muscular layers of the cervix in patients with benign uterine diseases. Patients and methods. A total of 366 patients aged 41 to 57 years were examined. Patients were divided into two groups: the study group (n = 254), which included patients who underwent laparovaginal subtotal hysterectomy with excision of the cervical mucosal and muscular layers using a modified cutting instrument (surgical cutter), and the comparison group (n = 112), which included patients who underwent total hysterectomy. All operations were performed by a laparoscopic approach. The duration of postoperative outpatient follow-up was 1–48 months. Results. In 88.6% of patients in the study group, there were no pronounced vegetative-vascular and psycho-emotional disorders, exacerbation or worsening of chronic somatic diseases; 56.3% of patients in the comparison group had clinical manifestations of the post-hysterectomy syndrome. Deterioration in the quality of sexual life (reduced libido and/or anorgasmia) was observed in 9.4% and 36.6% of women in the study and comparison groups, respectively. Vaginal vault prolapse was revealed in 3.6% of patients in the comparison group and vaginal vault granulation – in 4.5% of patients 2-3 years after surgery. No similar complications were registered in the study group. Conclusion. Subtotal hysterectomy with excision of the cervical mucosal and muscular layers using the presented technique can serve as an alternative to total hysterectomy in patients with benign uterine pathology. Preservation of the uterine suspensory apparatus, innervation, and blood supply of the cervical stump and the upper third of the vagina reduces the risk of pelvic floor anatomical and functional disorders and minimizes the possibility of post-hysterectomy pelvic organ prolapse. The proposed method of hysterectomy helps to reduce the duration of surgery, blood loss, the risk of intra- and postoperative complications, to minimize the development of cervical stump diseases and improve patients’ quality of life. Key words: subtotal hysterectomy, total hysterectomy, cervical mucosal and muscular layer excision, laparoscopy, surgical cutter, post-hysterectomy syndrome