nr : ai r oi'or il n a n il r .r n rir rl o .rlul: { rl u r u r a q?

u vr f
Total Abdominal Hysterectomy in Surin Hospitaf

u?{ril: ?ffnrcurffzud *

Abstract

Objective To study the incidence, indication, pathologic findings and compli-

cation of rotal Abdominal Hysterectomy (TAH) in surin Hospital.
Design Retrospective study

Setting Department of obstetrics and Gynecology, Surin Hospital.

Subjects Two hundred and seventeen patients who underwent TAH in Surin
Hospital, from January 1,2001 to December 31, 2001.
Result There were J3.567o of TAH from the whole hysterectomized
patients in this year. Most of the patients were multipara (parity>

2 70.057o) between 30-49 years old (84.33Ea). The most common

symptom was lower abdominal pain (38.257o) and the most
common indication was Leiomyoma (58.537o) followed by CIN+CIS

and Adenomyosis. The morbidity were fever, excessive bleeding

and infection.

Conclusions The incidence of TAH was 73.567o from the whole hysterectomized

patients. Most of the patients were married, multipara and came to

hospital with symptom of lower abdominal pain. The most common

indication was Leiomyoma and the morbidity were fever, excessive

bleeding and infection.

Keywords Total Abdominal Hysterectomy , Indication , Complication.

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snrr(ir eriu nr1 r ur:n#oufi drri'ry6o nll y'[fl fi rd o sr oonu rnfro.r1#r6o el

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d - , v - v A. a ay
n0 Leiomyoma (5ouav 58.53) Rt'lyrrm:n6foufrdtrIrU no nrry'[r]
rd o n o o n rr n ff0.rlfr rf, o o vr o rryr u rra ;fl r : r ii'n rau sr' 0 rdo
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Nrlun,a& - A{ulnN 2545 n n il ria un an n t t urt ti o tTuIz.tw u'r u t a 4iuni

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n't:ri'ptiloan (Hysterectomy) ifr oii'u ua yinurornr :fi qiln fr Io u'lilff0{ ra"'el

cll , - i. - o a d
tilun r: fl I 9t 9lytmtnuilt n [uT I nd9lfl1 d9t i lra y ilaan tdu Endometrial Polyp, Submucous
ui rrryim ur Io uolo rfl unr: il r ri'o oluri'uao.: Myoma riJuffu uonornd nr:l#riruuyrir
:o{ornntrilrqionaofl(') nr:r.itrifl T\H ru a v rJT n u r d r u ri'u niu fr rJ : u'lu uu I m r q nI T in u r
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dt v X- u 4 ytt i o e,
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rlludu uonornfrd.:rfrn nrrufruuJ6o,r ii'u ru19r0 ttnrnt:ta0nru!2u1t
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tl4}Jtyetil 0{1.1 tilu
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do
(2) rul o Hn ut olvl-d nr :n'l : ilt ri'el rJ qa n oo n
il fl a fl lfi r.r d'n r el' u r fi'u ri'u n r : ni r ra"'et vir'lil
I I r <a 9i t ytt yrtlvrrilfiol (Total Abdominal Hysterec-
lJ:vfl't:tt:n tfl0y'ruT?nruil2u tyur.til'lu
<urt tomy ; TAH) d'nunrvtor rirh udrutl:ru urura
nn [aoqila{fl ooao u]{:u rr:': Tpr ufi :yl'ufr: u
florir#1unr:r'irpifl ua vnr'l r um:n#oufi rfi e,;flu
nr:'lfr ut ufr']1ri6;flu rl:vnr:fi aor udol::rmr
d v rl I 4 a
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1!
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tljufl t:flnu1 u0uila{ '
[u flU il1 u1'l,.n9t9l
dvdtvtlli/[
tuyt0.t tljugru ]J:vflt:Yt6lttJ tv'l0ttn tln?1il tvd

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TAH druru 217 z1t) :;14?t{?UYl 1 rn:rnru
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cl um r 4 d dt
uit:i:i [1 14:0tv't0tljunt:n]Jnttugr0l?:
I (Hysterectomy) vtu.:ttttpr 295 :tu ttrir
dt U od94 r n lo dl
tlJugtu vt] t?tilnI:,.t't919ril fl an0 ut.: tll0I tuu riJunr:ilrd'o TAH 217 :ru (Youay 73.56)
d , d a d i. ov
il00uuilyn.t
t!
ta0n0u vtvn tilnt: 2tfl 9rtJnan rravillElhmlrriornaoq (vaginal hysterec-
afldrulua{ tdu nr:1#ur:J:rtnm GnRH tomy) 78 :ru (Youar 26.44)
 -t't1al11n]Jtll^lYlti

E qN1N1 iindilliryei 1:lnururRaia:lnu .liuvli uiflti

J"
el't:1{fi f ,irtrunnr:ilrn"'n TAH n]iln6i}Jo'lu
tt

orq 6l) :1U :o uav

<lg 2 0.92

20-29 4 1.84

30-39 53 24.42

40-49 130 s9.9t

50-59 23 10.60

260 5 2.31

:ltJ 217 100

t yrr{rJrsfi'lfriunr:rirsrier reu lun{r on

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rflunriruoru 30-39 fl Youav 24.42

nr:rrfi 2 rraqrdru:uuer:

v
0tu?uu9t: :-l u :0uay

Tapr/0 26 11.98

I 39 t7.97
2 57 26.21

J 55 25.35

4 27 t2.44
>5 l3 s.99
:?TJ 217 100

nr:rrfi z rrufrrjrufiaarunrilIaquar'lrifiusr:Youav
{ ! r 1.98 uonr?udrulnnifiufl:
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nufiu'lr] Souay 70.05
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j)
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:lxnr: (5ouav 11.52)

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4y q 9)
iln0utuYl0.: 65 29.95
4r
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ua1- 11.97)
r ty
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1:rwururnflia:rnu diuyri uiSud

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!
r r.r fi lir vio r rra ; ru a mt { v{ u rBa T U r fi rnr l dr l
AAdI
,{ a il1 il?I ut fi ? Yt u1 Yt il u :?il
Leiomyoma Adenomyosis
Endometriosis
Endometrial polyp
Endometrial hyperplasia
Benign ovarian cyst
Leiomyosarcoma
Normal(lilU)
CINX, CISX Adenomyosis
Benign ovarian cyst
Leiomyoma
Endometriosis
Adenomyosis Leiomyoma
Endometriosis
Normal(2ilU)
Ovarian tumor Benign ovarian cyst
Malignant ovarian tumor
Infection - TB peritonitis , TOA*
Endometriosis Adenomyosis
Leiomyoma
AUB* Leiomyoma
Adenomyosis
Endometrial polyp
Pelvic mass Endometriosis
Benign ovarian cyst
Leiomyoma
Molar pregnancy 6 Choriocarcinoma
Recurrent DUB* J Submucous myoma
Endometrial polyp
Uterine atony 2

Mental Retardation I
ild rz ariud z
nqunlart - flrurnr.r 25+5 nniltoinanannxuitfratluit.tnututaaiuni d
*CIN - Cervical Intraepithelial Neoplasia
CIS - Carcinoma in situ

TOA - Tuboovarian absecss

AUB - Abnormal Uterine Bleeding
DUB - Dysfunctional Uterine Bleedino
A-v,3
en:r{yl= 5 toil.:Byruilrnfiqfl
t!
lunr:r;l''et:letqn 6o Leiomyoma (Youor 58.53) :0.:

ailJttilu CIN + CIS, Adenomyosis etlildtelix (3ouar 11.06, 10.14)

en:t{fi 6 uanlrlnnnr:

n1:r,r-r9r9r Eiruru (:ru) :ouav

TAH 25 tt.52
TAH + Unilat.SO 13 5.99

TAH+ Unilat.SO + Appendectomy 16 7.37

TAH+BSO 85 39.17

TAH+BSO+Appendectomy 54 24.89

TAH+B S O+Appendectomy+Omentectomy 5 2.30

TAH+Appendectomy t9 8.76

:lll 2t7 100

en:l.:fi 6 #nnnr:firrv,ryrrili-rd?lJri'unr:r.ird'prrunanrrwrlilfro.:ilrnfidq 6o TAH+BSo

(5ouar 3g.17):o{a{il1tilu TAH + BSO+AppenO".,o*y (Youav Z+.Agl

nr:16r:Jruriounr:,.i'1r4"'a rryurfluT:nrutlt?-lu 10 :ru nrrrri'ulafina.: ttaul:n

',
v X so 4 r ^ I <4 q9/4
ndrurfrori:'[orrqrdoq otixay 8 :ru Rr?urrm:n6outturr.ireie frtdoqoonrtn6o.t'[titaoo

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!

rtr'{adnrdu rravrr,{attun 1nr:r.rfi Z;

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't11d1:n11111,{ytu

en :r { fi 7 nr r v rrm :n #o u ri o u ait ri'o I il y rit gt''q ua iila-{ r,i I ri'et

v
R1f,VUil:ncUOU 01u?u

1. riounr:ilrn''er
tul?t?-lu l0
nrrrriulofisrar 8
,, X uo 4
narilruo?r? t01Jrflra0a ti

140X149t 2

flrurr.irri'o

Ureter injury I

Bladder injury I

Excessive Bleeding 2l (9.68Vo)

3. nii":rirsriel

Fever 48 (22.12Eo)

Vaginal cuff infection 8

UTI 7

Wound infection J

Wound evisceration I

?01:il {:-h unq'ldnr:'lffiunr:fr 0] :rur o dr{ :oun ou

. < lu v- r r u 9tt d d y
d 9t : 1t tfl :x nt : r.,t1 9t 9t u n a n 0 o n Tt.: n0urut9t9t ry]J?utJ0'rsl^trnun:n::il iotJoy
,'
yrirvio.: (TAH) #,nur 2tl ttl ritulr,rqj 63.60 6.:ri:utrnrinrt o nr:erua rorloki
cll dq u I ,,
^
rfluasrEi'u ro3ryfiur{ ilrnnilfouar 50 oqjtu dlRty,lflo.t9tuto{ o'lo tfi o{}Jtolnnl:ltqn?1il?
ndrorq 40-49 fl rriurdurnilnr:finurodu'r'o) f rl#rfr prT:n rir.: 1 fi ar ru r :n il o.r ri'u'lfilJr nn ?';
vA ,d
lluorulioufiqo 13 fl rflurhjru Mental n ci u6u 1 oInI :il ? er fr o,r rio u riJu o I n I :iir n"'su
t o v,s s j
Retardation dor,,uruu{lillfr ffrj:uri:u 1lut,.tlJ?ulJt [:lvltJturo SlriJuornr:nyll
f, dt

lurludl.nuuflr uarfiuqr: 2 nursuhJ udfi ilrnfi aqluffrJr uuirrry uv{m dn.l:Er:?0 runlfi
9tt < v etYe,
{rJrufrrSouar I 1.98 fi.:ti.:'lilfiusr:rau ryfl ro ui ro r nr :fu rijuat r?tn ot nl:nmt luir:y
ifi rz qr;ud z
rqunrnN - Atl,lm& 2545 n fi 1d'oufiOnn1,rui1io t"lub.tNu1u 1itdiuni

violil i.,
n r:1#nrur aulo1unr:ry'nrj:yi6 ua: 10 iflu?uruu0tn l:ulo1l0.lu0u str u
er:ioir{nruTqua;rduo oytirlfi eirhal6ir o rnr:filfrqo rnvi u rBan rxdu
]nnitoyriltr
AYASJ
nr:ifr o6i'uriounr:r.iro"otdotir.:nndo.r [:0{noufl0.1[u0.:0n tou9t:{fn{0 tnn t:flnu ]0u
,,,x)
,[ori.rBfrulu rnfrao'txn
" ]:il I t$rh TAH
jv,, v A
fr rirl: u:r rdruGorflouuarrfioo :yii rr6ou

lul:{lrt tu taq;um{ 6o L"io.yornu oon 1fl(7) zuato{y{u1B:aurfirinr,l:t

,4 - i ,rr, .i
I u{ tuou sl - s:
-^ -^ rnu rotJlflut
(roudv 5E.5J) d:uril Leiomyoma niu Adenomyosis.
Leiomyoma r.^rllu fiilr uui rrro'uoilfru 1 Endometriosis, Endometrial hyperplasia
i4
fl l :1"1 i :
t ult 0 I n tt?t : 0 lJ
I r.l I fl 91 0 ;11 1 tu: I lIunu llufiayru ]fi?ytut na I :tu trt
",1 .:d
floulorfi fl uryirriuoron::ri I 2 d'rlor#;uYutl d'urir:oraur 6o CIN+CIS (Youa; I1.06)
ruriirlurloouiu [ru]ln{nr:iflul[ 6ouh] fi
)
6r{nt101{u}Jtnlut:0u z,{ r
1 tu0{01n}Jflt:
nr:1{nr:sr:rosrosrrl lun:tifi firh uri{'lri : :int?r nt:o:t0nofl:0nlJ:t5.t ln nan
fl0{nl)-fll9lO ltd rdflUtU;I0{n0U t}J n l:n9] (Papsmear) rirlfrfl ur,r0rBanry{dfi oilnA
c.
tu uo 0191;fl I itnu{ u0n0lnu}Jnt:[1ut
I i - I d.{
10.:uln oantlatuu 61 6Iito]Jt]r0u!n nt:
1r:ttlnolnlton tflu (NSAIDI5 6)
lunr:ao anat 1J0i Iti{utn
tfl[[dt e,x
" 110uin
9tan
n'r'l t6x loorn Red degenerarion ua:do o1uo1:ldril 6o Adenomyosis finlluitlnil

:Jiutrur6oooon lfirioual yiol{ cnRH Leiomyoma, Endometriosis i,!ufl aTt{

analogue rfi oritlfi t/rutn1flutljflFr 2 i'tu fl l:flnu r0ln' tJofl
rfr ontrv pseudomenopause
{^
ttagTt I n0utu0.!0n]J:tJlftSaqdi 0{:0uav 50
. .,x"
60.:to.: iori.:Slunr:r.irsi'o reu 1u
nd'.rliorlil 3 16ou rvurvdovl{iurri'rnr: I:lyi u ru raa.rt a runiuvr{ r,wir Leiomyoma
,
r.irri'o Myomectomy ri': tra onr: tiltr t6o o r-,,,9] A
utduirrflngra.r rnyldo (5erun: 84)
rua r ri r'tfi e.i r sio'ld i r
s il5. o't,fi","lu fi il r u1n # [[arioil{fr
uiu ",x Adenomvosis nndorrioufiao
I '',
11:.tO1l)-v0tLO0U t1^10 0 r "to'a"[t.lo0.t1nn ]: H tgto (iooa; 34.9)(')
Xael
1ul9tafla{ [ - t.,
tllilt tu0n0nn; 0t4uq ririrrrilnrr,.irsin TAH
fsronr:fr
::orrgt0u florduao 0'lt tnu 6 toou 010 il1nfiqq 60 TAH+BSo (fosa: 39.17)
i .-lc, &
uflfi'tr:0{ n:;qnfl:u n:iuTn 0utu0n 0n}J^ to{a{ 1 60 TAH+BSO+Appendectomy
rurfl'hilnilrnfn ororirlfiifr od'ufi orratq tfl u (iorJdz 24.89; lul:rr,rurrraqiuvri
,^. )
Adenomvosis [Fr ry{fl anl t?!utn2fl u tl,iutl}J fi or:rurrioirtrivrvr z {rr lun:dfi fi vrurB

fl-u"loli r] u n {0't 0 ulu tl,tfl t14 0 1n I 5u1d lnfu dn rfl:uu:iliiorirhuoturfru +s il fuhl

 l tldtn.}l(r,{mu
E ufl1w1 )TflUtltlatata Ir$rururRaid:rnu dilrfi uii&ti

nr: r.irsrioi.:'ldrY.r z {r'r lu {rh uor qrio tr n'jr 22.12 (qruilQfrnlfl > 38'c rJ:rnnoqjotit
+s fl ovrhl#ffrl:urdardonre:rrnaoil u riou z iuludrr 1o iuu:n eJnfiu 24
. i. J" - , - .l q < - { i
ro alor:roufr ai r: o rn:i"[ri ri : rilu'[rj 6r o rrio 1'r [r.r.r rr:nYd.rr.r r9r9)1111i'l1rdIr n]iFrfilxoYl
. ,.y Vaginal cuff, UTI, ttr.ra6ot#o uruatttln
I rflon:t ,'10uno {1r r{9llud:i ]11tJ'110i

:;urirl l uavmrrdruin'lo ornr:'[u::u v fiorna'u r{ruoul:{rr uru1al }i (l :rs) fi

< - - ji e J"",
n 1:flfl Ulljn0 g tnS lTrl.iTvll tYtnq
#utduri hot flashes ntviun:v?.ru tTYA lr.l lglfl

vto14.tottu tljuslu 0 tfl t::vuvult tottfl TAH urjrrfroorn l. nr:1fi Prophylactic

coronary heart disease ttav osleoporosi\ antibioric 2. :ruvrrarlunr:r.hoh 3. nrtr
nr:'[firir "i
rrur rrrriri lu'turi0.rt0.r HRT riru rot o.r fir.lrsio "' uonorndnr:[6uiJel
,
ltaint: "q.i
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I
[non']:dtu tdu ta0o )n9 0 i tfita0oT9tul1u 2l OIUU:tlt UitJn?l nlt U Uofl0tnlty,tTUOI
:rtr lYouar q.o8t ya'lilrerh finn:1{ Yooar fro rfinrrru:orn ol ua:n rr urirur ru'lu n r:
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r.ir srifl uffr rir fr o.: r{ rfi r d.: ffrj:

U! u
6.r riJu ff'lffir [ondr:d]{A.t
v
ruoRiymulq u a:{ il-.tyt t.t frrudr,:nr u rra y6 fl10 l. Timmons MC, Addison WA. Current
nr:oBrrud{n?ril,irrilulunr:niroio,{a for hysterectomy. In
indication :
y 4
^ 3 nv
ttm:nry0ury{0t0tnq1u
t
t9t1ilrfltFl9l ttayiia Stovall TG, ed. Hysterectomy.
nrrmufi ilrn"'o srTonral#frr]r u"i'nnrilflo
a-{ rfl
v Amsterdam : Elsevere Science
arii'u ua yr;r"'etfru'lo6r uflu ro{ o yr{r1#frrjr
v
u Publishing, 1993 : 17-25.
il fl-{ ? a ua 3 il iu d'.r,i r f,r"'fl 'lfr r
naIun?I er-: H 15
2. Thompson JD, Rock JA. Appropriate

indication for hysterectomy. Te linde's

,
CI:lJ
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6tuyV
yru 0unnl:nt:r.,lt gt9tiloanml{ilutyl0{ delphia : J.B.Lippincott, 1992 : 610.
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Youov I 3.56 fl o.:nrrsitsthilr'an#.:Hrue,

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lu 3. nruardu# yilrdi. Hysterecromy in
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ro3rur(ufuarfiun:rfi
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vvdri
r4o.:rio rljuor nt :fr dr ffrJr uilrI:{y,t urura
u +. mqri ri'u6u::.rri, nrid nrrUou0?iari.
v 'XA i 4
{orilBfrnrlrnfraodo
i
Leiomyoma (Youay nt : ilr srio ru or an r r.tl.tflt fr o {lul:{ il u r ti r a
58.53) nr?vum:nfioufiurldonrry'[{ r6opr nynrfnflufl lurJ:yxrru 2536-2538.
00nilln ^{
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oururn'lfrrirnr:finur
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-XyyA
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r?Td]:du r1lfl rra vn6ilJ{lull urEim ur'[unr: :22:727 - 38.

'[#nrrui:1fi olunr::u:rrufroua
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u4tVA
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t

during 1990 - 1992 . Reg 1 I Med J

1994 Jan- Dec 8 ; ( 1-3 ) : 29 - 42.

E
1116111n11tt1,lmd
u w't N7 ) qn?t tu't f, tu it 1:rwururRaid:rnu 4itrvri llifNd

8.
duauaaa
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vY,Xta Lumbiganon P. Febrile and infections
n?1}J n n n0 {1 0 {lJ 0u {ry10.1 fl 1 : r.ll 9}91

lJ oa n m'r.: 14lir fr o rlul:.: r,r urur ad{ I a1 morbidity after abdominal hysterec-

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9.
d u
?::rurviE rurunsu. rvr?uvr: tndufl :rna.
a ds
t2. ofiryrn ii'n:i4r. nr:uJiuurfiuunr?vfi
d au dn X un, iY u t u v Y r a4
r?rturrl ilmn! tll:?u.
-
tu0{0fl:{ tI t1J ntuila{fl t: r.t tnnHutvt0{:v14'lt{?fi
dsd dAtrtr<dd
fl I U?1A{ n t:fl 9r}JqA n. ?t:d]: [:n]J r t:.1 tuulJgrd?uljatuT0{na0q ttav?Dtuu
U

2531 :14 : ll5-21. rflsrci:urJarusio{naoq. 1'r:dr:

10. Christ JE, Lotze EC. The residual I:rvrururaryaui 2540 ;22: I - 14.
ovary syndrome. Obstet Gynecol 13. Scott JR, Disaia PJ, Hammond CB.

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