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手术治疗盆腔器官脱垂和尿失禁再手术的流行病学评估

Epidemiologic evaluation of reoperation for surgically treated pelvic organ prolapse and urinary incontinence.

作者信息

Clark Amanda L, Gregory Thomas, Smith Virginia J, Edwards Renee

机构信息

Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Oregon Health and Science University, L466, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.

出版信息

Am J Obstet Gynecol. 2003 Nov;189(5):1261-7. doi: 10.1067/s0002-9378(03)00829-9.

Abstract

OBJECTIVE

The purpose of this study was to measure the risk of reoperation for surgically treated pelvic organ prolapse and urinary incontinence in a community-based population.

STUDY DESIGN

A 5-year prospective, observational study was conducted of women who had undergone pelvic organ prolapse and urinary incontinence surgery in 1995. The cohort of 376 women was identified by International Classification of Diseases, 9th revision, and current procedural terminology codes in 149,554 reproductive-aged women within the Kaiser Permanente Northwest membership.

RESULTS

Thirty-six women underwent 40 cases of reoperation. By survival analysis, 13% of women underwent reoperation by 71 months. Having undergone previous pelvic organ prolapse and urinary incontinence surgery increased the risk of reoperation to 17% compared with 12% for women who underwent a first procedure (log rank, P=.04). No association was observed with age, body mass index, parity, previous hysterectomy not for prolapse, vaginal versus abdominal approach, severity of prolapse, ethnicity, chronic lung disease, smoking, previous corticosteroid use, and estrogen status.

CONCLUSIONS

Future reoperation is a significant risk of morbidity for women who undergo pelvic organ prolapse and urinary incontinence surgery.

摘要

目的

本研究旨在评估在以社区为基础的人群中,接受手术治疗的盆腔器官脱垂和尿失禁患者再次手术的风险。

研究设计

对1995年接受盆腔器官脱垂和尿失禁手术的女性进行了一项为期5年的前瞻性观察研究。通过国际疾病分类第9版和当前手术操作术语编码,在凯撒永久医疗集团西北分部的149,554名育龄妇女中确定了376名女性作为队列研究对象。

结果

36名女性接受了40例再次手术。通过生存分析,到71个月时,13%的女性接受了再次手术。与首次接受手术的女性(12%)相比,曾接受盆腔器官脱垂和尿失禁手术的女性再次手术的风险增加到17%(对数秩检验,P = 0.04)。未观察到与年龄、体重指数、产次、既往非因脱垂行子宫切除术、经阴道与经腹手术方式、脱垂严重程度、种族、慢性肺病、吸烟、既往使用皮质类固醇以及雌激素状态之间存在关联。

结论

对于接受盆腔器官脱垂和尿失禁手术的女性,未来再次手术是发生并发症的重大风险。

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