Lethaby A, Ivanova V, Johnson N P
School of Population Health, Section of Epidemiology and Biostatistics (Level four), Tamaki Campus, University of Auckland, Private Bag 92019, Auckland, New Zealand.
Cochrane Database Syst Rev. 2006 Apr 19(2):CD004993. doi: 10.1002/14651858.CD004993.pub2.
Hysterectomy using an abdominal approach removes either the uterus alone (subtotal hysterectomy) or both the uterus and the cervix (total hysterectomy). The latter is more common but outcomes have not been systematically compared.
To assess and compare outcomes with subtotal hysterectomy versus total abdominal hysterectomy for benign gynaecological conditions.
We searched the Cochrane Menstrual Disorders and Subfertility Group's specialised register of controlled trials (December 2005), Central (December 2005), Medline (1966 to December 2005), EmBase (1980 to December 2005), Biological Abstracts (1980 to December 2005), the National Research Register and relevant citation lists.
Only randomised controlled trials of women undergoing either total or subtotal hysterectomy for benign gynaecological conditions were included.
Three trials that included 733 participants were included. Independent selection of trials and data extraction were undertaken by 2 reviewers and results compared.
There was no evidence of a difference in the rates of incontinence, constipation or measures of sexual function. In one unblinded trial, a significantly greater proportion of women indicated that they had frequent episodes of urinary incontinence after subtotal hysterectomy when compared with total hysterectomy (OR=2.1, 1.02 to 4.3), but these results were not confirmed by the other two trials that measured both stress and urge incontinence and urinary frequency. . Length of surgery and amount of blood lost during surgery were significantly reduced during subtotal hysterectomy when compared with total hysterectomy, but there was no evidence of a difference in the odds of transfusion. Febrile morbidity was less likely (OR=0.43, 0.25 to 0.75) and ongoing cyclical vaginal bleeding one year after surgery was more likely (OR=11.3, 4.1 to 31.2) after subtotal when compared with total hysterectomy. There was no evidence of a difference in the rates of other complications, recovery from surgery or readmission rates.
AUTHORS' CONCLUSIONS: This review has not confirmed the perception that subtotal hysterectomy offers improved outcomes for sexual, urinary or bowel function when compared with total abdominal hysterectomy. Surgery is shorter and intraoperative blood loss and fever are reduced but women are more likely to experience ongoing cyclical bleeding up to a year after surgery with subtotal hysterectomy compared to total hysterectomy.
经腹子宫切除术可单独切除子宫（次全子宫切除术）或同时切除子宫和宫颈（全子宫切除术）。后者更为常见，但尚未对其结果进行系统比较。
评估并比较次全子宫切除术与经腹全子宫切除术治疗良性妇科疾病的效果。
我们检索了Cochrane月经紊乱与生育力低下研究组的对照试验专门登记库（2005年12月）、CENTRAL（2005年12月）、Medline（1966年至2005年12月）、EmBase（1980年至2005年12月）、生物学文摘数据库（1980年至2005年12月）、国家研究注册库及相关引文列表。
仅纳入因良性妇科疾病接受全子宫切除术或次全子宫切除术的女性的随机对照试验。
纳入了3项试验，共733名参与者。由2名评价者独立选择试验并提取数据，然后比较结果。
在尿失禁、便秘或性功能指标方面，没有证据表明两者存在差异。在一项非盲法试验中，与全子宫切除术相比，次全子宫切除术后有更高比例的女性表示有频繁的尿失禁发作（比值比=2.1，1.02至4.3），但另外两项同时测量压力性尿失禁、急迫性尿失禁和尿频的试验未证实这些结果。与全子宫切除术相比，次全子宫切除术的手术时间和术中失血量显著减少，但输血几率没有差异。与全子宫切除术相比，次全子宫切除术后发热发病率较低（比值比=0.43，0.25至0.75），术后一年持续性周期性阴道出血的可能性更大（比值比=11.3，4.1至31.2）。在其他并发症发生率、手术恢复情况或再入院率方面，没有证据表明两者存在差异。
本综述未证实与经腹全子宫切除术相比，次全子宫切除术在性功能、泌尿系统功能或肠道功能方面能带来更好的结果。次全子宫切除术手术时间更短，术中失血量和发热情况减少，但与全子宫切除术相比，接受次全子宫切除术的女性在术后长达一年的时间里更有可能出现持续性周期性出血。
