背景:子宫切除术可能对盆底有影响。这里,我们评估了有子宫切除术史的女性盆腔器官脱垂(POP)手术和就诊的发生率和风险,以排除POP的良性适应症.
方法:在这项回顾性队列研究中,对2006年接受子宫切除术的3582名妇女进行随访,直至2016年底。该队列与芬兰护理登记册相关联,以捕获子宫切除术后与脱垂相关的任何诊断和手术代码。根据子宫脱垂的风险比较不同的子宫切除术方法,包括腹部,腹腔镜,腹腔镜辅助阴道和阴道。主要结果是POP手术和POP门诊,和Cox回归用于识别危险因素(风险比[HR])。
结果:在随访期间,58名妇女(1.6%)接受了POP手术,其中后路修复最常见(n=39,1.1%)。92名(2.6%)女性发生POP症状的门诊就诊,其中后壁脱垂(n=58,1.6%)最常见。腹腔镜辅助阴式子宫切除术的病史与POP手术的风险相关(HR3.0,p=0.02),与经腹子宫切除术的方法相比,阴道穹窿脱垂手术(HR4.3,p=0.01)和POP访视(HR2.2,p<0.01)。阴道分娩和伴随的压力性尿失禁手术史与POP手术(HR4.4和11.9)和POP就诊(HR3.9和7.2)的风险相关。
结论:在子宫切除术后至少10年,无POP的子宫切除妇女POP手术和门诊POP症状的风险似乎很小。LAVH的历史,阴道分娩和伴随的压力性尿失禁手术增加了子宫切除术后POP手术的风险。这些数据可用于咨询考虑子宫切除术的良性适应症的妇女。
Hysterectomy may have an effect on the pelvic floor. Here, we evaluated the rates and risks for pelvic organ prolapse (POP) surgeries and visits among women with a history of hysterectomy for benign indication excluding POP.
In this retrospective cohort study 3582 women who underwent hysterectomy in 2006 were followed until the end of 2016. The cohort was linked to the Finnish Care Register to catch any prolapse-related diagnoses and operation codes following the hysterectomy. Different hysterectomy approaches were compared according to the risk for a prolapse, including abdominal, laparoscopic, laparoscopic-assisted vaginal and vaginal. The main outcomes were POP surgery and outpatient visit for POP, and Cox regression was used to identify risk factors (hazard ratios [HR]).
During the follow-up, 58 women (1.6%) underwent a POP operation, of which a posterior repair was the most common (n = 39, 1.1%). Outpatient visits for POP symptoms occurred in 92 (2.6%) women of which posterior wall prolapses (n = 58, 1.6%) were the most common. History of laparoscopic-assisted vaginal hysterectomy were associated with risk for POP operation (HR 3.0, p = 0.02), vaginal vault prolapse operation (HR 4.3, p = 0.01) and POP visits (HR 2.2, p < 0.01) as compared to the approach of abdominal hysterectomy. History of vaginal deliveries and concomitant stress urinary continence operation were associated with the risk for a POP operation (HR 4.4 and 11.9) and POP visits (HR 3.9 and 7.2).
Risk for POP operations and outpatient visits for POP symptoms in hysterectomized women without a preceding POP seems to be small at least 10 years after hysterectomy. History of LAVH, vaginal deliveries and concomitant stress urinary incontinence operations increased the risk for POP operations after hysterectomy. These data can be utilized in counseling women considering hysterectomy for benign indication.