Vessey M P, Villard-Mackintosh L, McPherson K, Coulter A, Yeates D
Department of Public Health & Primary Care, Radcliffe Infirmary, Oxford, UK.
Br J Obstet Gynaecol. 1992 May;99(5):402-7. doi: 10.1111/j.1471-0528.1992.tb13758.x.
To examine patterns of hysterectomy in the Oxford-Family Planning Association (Oxford-FPA) study in relation to age, parity, social class and calendar period (-1974, 1975-79. 1980-84, 1985-89).
The Oxford-FPA study is a large scale prospective study of 17,032 women recruited from 1968-74 and still under observation.
Seventeen family planning centres throughout England and Scotland.
At recruitment the 17,032 women were all white, British, married, aged 25-39 and willing to co-operate. In addition, they were using the pill or an intrauterine device or a diaphragm as their method of contraception.
Hysterectomy rates per 1000 woman-years of observation in various subclasses of the data.
Up to the end of 1989, 1885 (11.1%) of the 17,032 women in the study were known to have undergone hysterectomy. Fibroids were the most common cause followed closely by menstrual disturbances in the absence of fibroids (hereafter referred to as 'menstrual disturbances'). Social class had a modest influence on hysterectomy rates. Hysterectomy for fibroids, prolapse, endometriosis and 'other reasons' showed little trend with calendar period while hysterectomy for menstrual disturbances and for cancer showed a sharp increase with calendar time especially at ages 30-39. Hysterectomy generally tended to increase with age and showed a strong relation to parity; in particular, hysterectomy for fibroids fell with parity and hysterectomy for menstrual disturbances rose sharply with parity. Using lifetable methods, it was estimated that almost 20% of the women in the study would have had a hysterectomy by age 55.
The results give insights into factors affecting hysterectomy rates. Of particular interest is the modest influence of social class, the strong influence of parity and the rise in rates with calendar time at ages 30-39 for those undergoing hysterectomy for menstrual disturbances or cancer, but since the cohort is not directly representative of the population, some caution is required in extrapolating these findings. The estimated hysterectomy rate of about 20% by age 55 is in line with other similar estimates for the United Kingdom.
在牛津计划生育协会（Oxford-FPA）研究中，考察子宫切除术模式与年龄、产次、社会阶层和日历时间段（-1974年、1975 - 1979年、1980 - 1984年、1985 - 1989年）之间的关系。
牛津计划生育协会研究是一项大规模前瞻性研究，对1968 - 1974年招募的17032名女性进行研究，她们仍在观察中。
英格兰和苏格兰的17个计划生育中心。
招募时，这17032名女性均为白人、英国籍、已婚，年龄在25 - 39岁之间且愿意合作。此外，她们使用口服避孕药、宫内节育器或子宫帽作为避孕方法。
数据各亚组中每1000妇女年观察期的子宫切除术发生率。
截至1989年底，研究中的17032名女性中有1885名（11.1%）已知接受了子宫切除术。子宫肌瘤是最常见的原因，其次是无肌瘤情况下的月经紊乱（以下简称“月经紊乱”）。社会阶层对子宫切除术发生率有一定影响。因子宫肌瘤、子宫脱垂、子宫内膜异位症和“其他原因”进行的子宫切除术随日历时间段变化趋势不明显，而因月经紊乱和癌症进行的子宫切除术随日历时间急剧增加，尤其是在30 - 39岁年龄段。子宫切除术总体上倾向于随年龄增加，且与产次有很强的相关性；特别是，因子宫肌瘤进行的子宫切除术随产次降低，因月经紊乱进行的子宫切除术随产次急剧上升。使用生命表方法估计，研究中近20%的女性在55岁时会接受子宫切除术。
研究结果揭示了影响子宫切除术发生率的因素。特别值得关注的是社会阶层的适度影响、产次的强烈影响以及30 - 39岁年龄段因月经紊乱或癌症接受子宫切除术的发生率随日历时间的上升，但由于该队列并非直接代表总体人群，在推断这些发现时需要谨慎。估计55岁时约20%的子宫切除术发生率与英国其他类似估计一致。
