良性疾病行腹式和阴式子宫切除术后的近期和远期并发症

Short and long term complications of abdominal and vaginal hysterectomy for benign disease.

作者信息

Al-Kadri Hanan M, Al-Turki Haifa A, Saleh Ahmed M

机构信息

Department of Obstetrics and Gynecology, King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia.

出版信息

Saudi Med J. 2002 Jul;23(7):806-10.

PMID:12174230

Abstract

OBJECTIVE

To describe the indications, short, intermediate and long term complications for total abdominal versus vaginal hysterectomy, in women with benign pelvic disease.

METHODS

This study was carried out at King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia. Chart review was conducted from 1995 to 1999, for all patients who had hysterectomy for benign disease. We compared indications, short, intermediate and long term complications of total abdominal versus vaginal hysterectomy. A total of 108 patients who had hysterectomy were available for analysis. Group one consisted of patients who had total abdominal hysterectomy (N=82), and group 2 consisted of patients who had vaginal hysterectomy (N=26).

RESULTS

The principle indication for the vaginal hysterectomy was uterine prolapse 81%, which occurs in women >45-years-old. While, the most common indications for the total abdominal hysterectomy were menstrual disorders and uterine fibroids 56%, which occur in women <45-years-old. The overall complication rates were 51.2% and 23.1%, in women who underwent total abdominal hysterectomy and vaginal hysterectomy (p=0.01, odds ratio = 3.5). Twelve patients (14.6%) required 2nd intervention or rehospitalization, or both, in the total abdominal hysterectomy group, while none were required in the vaginal hysterectomy group. Febrile morbidity formed the major category of the postoperative complications in our study, total incidence was 27.8% (30/108). No statistically significant differences were noted between the total abdominal hysterectomy [30.1% (25/82)] and the vaginal hysterectomy groups [19.2% (5/26), (p=0.3)], nor for women who received antibiotic prophylaxis [25.5% (14/55)] and women who did not [28.3% (15/53), (p=0.7)].

CONCLUSION

Vaginal hysterectomy is associated with less intraoperative, intermediate and late complication rates than total abdominal hysterectomy. No significant differences in postoperative febrile morbidity, but significantly shorter hospitalization were noted among women who received antibiotic prophylaxis compared to those who did not.

摘要

目的

描述患有良性盆腔疾病的女性行全腹子宫切除术与经阴道子宫切除术的适应症、短期、中期和长期并发症。

方法

本研究在沙特阿拉伯王国利雅得的法赫德国民警卫队医院进行。对1995年至1999年期间所有因良性疾病行子宫切除术的患者进行病历回顾。我们比较了全腹子宫切除术与经阴道子宫切除术的适应症、短期、中期和长期并发症。共有108例行子宫切除术的患者可供分析。第一组由行全腹子宫切除术的患者组成（N = 82），第二组由行经阴道子宫切除术的患者组成（N = 26）。

结果

经阴道子宫切除术的主要适应症是子宫脱垂，占81%，发生在45岁以上的女性中。而全腹子宫切除术最常见的适应症是月经紊乱和子宫肌瘤，占56%，发生在45岁以下的女性中。行全腹子宫切除术和经阴道子宫切除术的女性总体并发症发生率分别为51.2%和23.1%（p = 0.01，优势比 = 3.5）。全腹子宫切除术组有12名患者（14.6%）需要二次干预或再次住院，或两者都需要，而经阴道子宫切除术组则无此情况。发热性疾病是我们研究中术后并发症的主要类型，总发生率为27.8%（30/108）。全腹子宫切除术组[30.1%（25/82）]和经阴道子宫切除术组[19.2%（5/26）]之间未观察到统计学上的显著差异（p = 0.3），接受抗生素预防的女性[25.5%（14/55）]和未接受抗生素预防的女性[28.3%（15/53）]之间也未观察到统计学上的显著差异（p = 0.7）。