目的:根据手术方法(腹部,阴道,或腹腔镜),并确定粘连性肠梗阻的危险因素。
方法:基于国家注册的队列。
方法:1984-2013年期间的丹麦医院。
方法:为良性适应症行子宫切除术的丹麦妇女(N=125,568)。
方法:将腹部子宫切除术与阴道子宫切除术进行比较,腹腔镜子宫切除术,和微创(阴道和腹腔镜)子宫切除术。
结果:使用Cox比例风险回归比较根据手术方法的肠梗阻发生率。包括的协变量是时间段,年龄,伴随行动,之前的腹部手术或疾病,和社会经济因素。在2004-2013年期间的子分析(n=35,712名妇女)中,来自丹麦子宫切除术数据库的详细信息使患者相关,手术相关,和并发症相关协变量。肠梗阻的总发生率为17.4/1000子宫切除术(2196例)。肠梗阻的10年累积发病率在手术途径之间有所不同(腹部,1.7%;腹腔镜,1.4%;和阴道,0.9%)。在多个调整后的分析中,与经阴道(HR1.64[95%CI1.39-1.93])和微创(经阴道或腹腔镜)子宫切除术(HR1.54[1.33-1.79])相比,经腹子宫切除术后发生肠梗阻的风险更高.子宫切除术时肠梗阻的其他预先存在的危险因素是年龄增加,低教育,低收入,吸烟,高ASA合并症评分,不孕史,腹部感染,和先前的腹部手术(剖宫产除外),腹部器官的穿透性病变,或手术粘连松解术。子宫切除术时的围手术期危险因素包括同时切除卵巢,粘连松解术,输血,重新接纳,以及围手术期并发症的总体存在。
结论:腹式子宫切除术与微创(腹腔镜或阴式)子宫切除术相比,肠梗阻风险高54%。
OBJECTIVE: To estimate the risk of bowel obstruction (BO) after hysterectomy for benign indications depending on the surgical method (abdominal, vaginal, or laparoscopic) and identify risk factors for adhesive BO.
METHODS: A national registry-based cohort.
METHODS: Danish hospitals during the period 1984-2013.
METHODS: Danish women who underwent hysterectomy for benign indications (N = 125 568).
METHODS: Abdominal hysterectomies were compared with vaginal hysterectomies, laparoscopic hysterectomies, and minimally invasive (vaginal and laparoscopic) hysterectomies.
RESULTS: The incidence of BO according to the surgical method was compared using Cox proportional hazard regression. The covariates included were the time period, age, concomitant operations, previous abdominal surgery or disease, and socioeconomic factors. In a subanalysis (n = 35 712 women) of the period 2004-2013, detailed information from the Danish Hysterectomy Database enabled the inclusion of patient-, surgery-, and complication-related covariates. The overall crude incidence of BO was 17.4 of 1000 hysterectomies (2196 incident cases). The 10-year cumulative incidence of BO differed among the surgical routes (abdominal, 1.7%; laparoscopic, 1.4%; and vaginal, 0.9%). In multiple-adjusted analyses, the risk of BO was higher after abdominal hysterectomy than after vaginal (hazard ratio 1.64 [95% confidence interval, 1.39-1.93]) and minimally invasive (vaginal or laparoscopic) hysterectomy (hazard ratio 1.54 [1.33-1.79]). Additional pre-existing risk factors for BO at the time of hysterectomy were increased age, low education, low income, smoking, high American Society of Anesthesiologists comorbidity score, history of infertility, abdominal infection, and previous abdominal surgery (apart from cesarean section), penetrating lesions in abdominal organs, or operative adhesiolysis. Perioperative risk factors at the time of hysterectomy included concomitant removal of the ovaries, adhesiolysis, blood transfusion, readmission, and overall presence of perioperative complications.
CONCLUSIONS: Abdominal hysterectomy is associated with a 54% higher risk of BO than minimally invasive (laparoscopic or vaginal) hysterectomy.