目的:本研究旨在对“子宫切除术时双侧附件-卵巢切除术的长期结果”进行最新的系统评价,并对所报道的相关性进行荟萃分析。
方法:我们的研究通过使用PubMed搜索文献来更新以前的系统综述,WebofScience,和Embase为2015年1月至2022年8月之间的出版物。
方法:我们的研究包括对进行子宫切除术并进行双侧输卵管卵巢切除术的女性与进行子宫切除术并保留卵巢或不进行手术的女性的研究。
方法:使用建议分级评估证据的质量,评估,开发和评估。提取并组合调整后的风险比,以获得固定效果估计。
结果:与子宫切除术或不手术相比,年轻女性的双侧输卵管卵巢切除术与乳腺癌风险降低相关(风险比,0.78;95%置信区间,0.73-0.84),但患结直肠癌的风险增加(风险比,1.27;95%置信区间,1.10-1.47)。此外,它与总心血管疾病的风险增加有关,冠心病,和卒中的风险比为1.18(95%置信区间,1.11-1.25),1.17(95%置信区间,1.10-1.25),和1.20(95%置信区间,1.10-1.31),分别。与没有手术相比,在50岁之前进行双侧输卵管卵巢切除术与高脂血症风险增加相关(风险比,1.44;95%置信区间,1.25-1.65),糖尿病(危险比,1.16;95%置信区间,1.09-1.24),高血压(危险比,1.13;95%置信区间,1.06-1.20),痴呆症(危险比,1.70;95%置信区间,1.07-2.69),和抑郁症(危险比,1.39;95%置信区间,1.22-1.60)。与年轻女性全因死亡率相关的证据显示,研究之间存在显著的异质性(I2=85%;P<.01)。
结论:双侧输卵管卵巢切除术与多个长期结局相关。在子宫切除术中增加双侧输卵管卵巢切除术的好处应与风险相平衡。
This study aimed to provide an up-to-date systematic review of \"the long-term outcomes of bilateral salpingo-oophorectomy at the time of hysterectomy\" and perform a meta-analysis for the reported associations.
Our study updated a previous systematic review by searching the literature using PubMed, Web of Science, and Embase for publications between January 2015 and August 2022.
Our study included studies of women who had a hysterectomy with bilateral salpingo-oophorectomy vs women who had a hysterectomy with ovarian conservation or no surgery.
The quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations. Adjusted hazard ratios were extracted and combined to obtain fixed effect estimates.
Compared with hysterectomy or no surgery, hysterectomy with bilateral salpingo-oophorectomy in young women was associated with decreased risk of breast cancer (hazard ratio, 0.78; 95% confidence interval, 0.73-0.84) but with an increased risk of colorectal cancer (hazard ratio, 1.27; 95% confidence interval, 1.10-1.47). In addition, it was associated with an increased risk of total cardiovascular diseases, coronary heart disease, and stroke with hazard ratios of 1.18 (95% confidence interval, 1.11-1.25), 1.17 (95% confidence interval, 1.10-1.25), and 1.20 (95% confidence interval, 1.10-1.31), respectively. Compared with no surgery, hysterectomy with bilateral salpingo-oophorectomy before the age of 50 years was associated with an increased risk of hyperlipidemia (hazard ratio, 1.44; 95% confidence interval, 1.25-1.65), diabetes mellitus (hazard ratio, 1.16; 95% confidence interval, 1.09-1.24), hypertension (hazard ratio, 1.13; 95% confidence interval, 1.06-1.20), dementia (hazard ratio, 1.70; 95% confidence interval, 1.07-2.69), and depression (hazard ratio, 1.39; 95% confidence interval, 1.22-1.60). The evidence on the association with all-cause mortality in young women showed substantial heterogeneity between the studies (I2=85%; P<.01).
Hysterectomy with bilateral salpingo-oophorectomy was associated with multiple long-term outcomes. The benefits of the addition of bilateral salpingo-oophorectomy to hysterectomy should be balanced against the risks.