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Perioperative Lungenfunktionsparameter und Schmerzanalyse nach unterschiedlichen Hysterektomie-Methoden

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  • Background: The conventional methods of removal of the uterus vaginal and abdominal hysterectomy. A new addition during the last couple of years in the laparoscopically assisted vaginal hysterectomy (LAVH). In our prospective trial we surveyed four groups each including twenty patients undergoing four different surgical techniques and compared them regarding perioperative respiratory function, pain analysis and patient records. Methods: Group I: laparoscopic assisted vaginal hysterectomy with CO2-insufflation (LAVH CO2) Group II: laparoscopic assisted vaginal hysterectomy gasless (LAVH gasless) Group III: vaginal hysterectomy (vag. HE) Group IV: abdominal hysterectomy (abd. HE) The perioperative respiratory function was evaluated with spirometry and impulsoscillometric measurement. The subjective pain level was assessed using a 100 mm visualanalogscore (VAS), the objective reviewing the amount of painkillers and patient controlled intravenaous application (PCAS). The records were analysed with conventional methods. Results: 1. Abd. hysterectomies influence the postoperative respiratoric function more than vag. Hysterectomies or LAVH's. 2. There is no difference regarding postoperative changes while comparing gasless and CO2-LAVH. 3. Postoperative pain is significantly higher after LAVH's than vag. HE. 4. Postoperative paine is worst after abd. HE compared with all other surgical methods. Conclusions: 1. The traumatisation of the area operated on is significant regarding the pathogenesis of postoperative pulmonal function and pain level. 2. There is no difference regarding postoperative changes of lung function regarding gassless and CO2-LAVH. 3. Spirometry mainly depends on the quality of instructions and the compliance of the patient. Therefore it is not as accurate to evaluate the postoperative respiratory function in comparison with impulsoscilometry. 4. This trial assessed only the postoperative respiratory function of patients without lung problems. Therefore it would be worthwile to do further research of the postoperative respiratory function of patients with lung problems.

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Author: Garri Tchartchian
Title Additional (German):keine Angaben
Title Additional (English):keine Angaben
Advisor:Dr. Bernd Bojahr
Document Type:Doctoral Thesis
Date of Publication (online):2007/02/19
Granting Institution:Ernst-Moritz-Arndt-Universität, Medizinische Fakultät (bis 2010)
Date of final exam:2006/11/07
Release Date:2007/02/19
GND Keyword:Gebärmutterentfernung, Laparoskopie, Schmerz
Faculties:Universitätsmedizin / Klinik und Poliklinik für Frauenheilkunde u. Geburtshilfe
DDC class:600 Technik, Medizin, angewandte Wissenschaften / 610 Medizin und Gesundheit