Thakar Ranee, Ayers Susan, Clarkson Peter, Stanton Stuart, Manyonda Isaac
Department of Gynecology, St. George's Hospital, London, United Kingdom.
N Engl J Med. 2002 Oct 24;347(17):1318-25. doi: 10.1056/NEJMoa013336.
It is uncertain whether subtotal abdominal hysterectomy results in better bladder, bowel, or sexual function than total abdominal hysterectomy.
We conducted a randomized, double-blind trial comparing total and subtotal abdominal hysterectomy in 279 women referred for hysterectomy because of benign disease; most of the women were premenopausal. The main outcomes were measures of bladder, bowel, and sexual function at 12 months. We also evaluated postoperative complications.
The rates of urinary frequency (urination more than seven times during the day) were 33 percent in the subtotal-hysterectomy group and 31 percent in the total-hysterectomy group before surgery, and they fell to 24 percent and 20 percent, respectively, at 12 months (P=0.03 for the change over time within each group; P=0.84 for the interaction between the treatment assignment and time). The reduction in nocturia and stress incontinence and the improvement in bladder capacity were similar in the two groups. The frequency of bowel symptoms (as indicated by reported constipation and use of laxatives) and measures of sexual function (including the frequency of intercourse and orgasm and the rating of the sexual relationship with a partner) did not change significantly in either group after surgery. The women in the subtotal-hysterectomy group had a shorter hospital stay (5.2 days, vs. 6.0 in the total-hysterectomy group; P=0.04) and a lower rate of fever (6 percent vs. 19 percent, P<0.001). After subtotal abdominal hysterectomy, 7 percent of women had cyclical bleeding and 2 percent had cervical prolapse.
Neither subtotal nor total abdominal hysterectomy adversely affects pelvic organ function at 12 months. Subtotal abdominal hysterectomy results in more rapid recovery and fewer short-term complications but infrequently causes cyclical bleeding or cervical prolapse.
次全腹式子宫切除术在膀胱、肠道或性功能方面是否比全腹式子宫切除术效果更好尚不确定。
我们进行了一项随机双盲试验，比较了279例因良性疾病接受子宫切除术的女性的全腹式子宫切除术和次全腹式子宫切除术；大多数女性处于绝经前。主要结局指标为术后12个月时的膀胱、肠道和性功能指标。我们还评估了术后并发症。
术前，次全子宫切除组的尿频率（白天排尿超过7次）为33%，全子宫切除组为31%，术后12个月时分别降至24%和20%（每组随时间的变化P = 0.03；治疗分组与时间的交互作用P = 0.84）。两组夜尿和压力性尿失禁的减少以及膀胱容量的改善相似。术后两组的肠道症状频率（以报告的便秘和泻药使用情况衡量）和性功能指标（包括性交频率、性高潮频率以及与伴侣性关系的评分）均无显著变化。次全子宫切除组的女性住院时间较短（5.2天，全子宫切除组为6.0天；P = 0.04），发热率较低（6%对19%，P<0.001）。次全腹式子宫切除术后，7%的女性出现周期性出血，2%的女性出现宫颈脱垂。
次全腹式子宫切除术和全腹式子宫切除术在术后12个月时均未对盆腔器官功能产生不利影响。次全腹式子宫切除术恢复更快，短期并发症更少，但偶尔会导致周期性出血或宫颈脱垂。
