Jacobson Gavin F, Shaber Ruth E, Armstrong Mary Anne, Hung Yun-Yi
Department of Obstetrics and Gynecology, Kaiser Permanente Northern California, USA.
Obstet Gynecol. 2006 Jun;107(6):1278-83. doi: 10.1097/01.AOG.0000210640.86628.ff.
To investigate the annual rates, types, and indications for hysterectomies performed for benign disease in Kaiser Permanente Northern California from 1994 to 2003.
All women, 20 years or age or older, who were undergoing hysterectomy for benign indications in Kaiser Permanente Northern California from 1994 to 2003 were identified. We analyzed hysterectomy rates by type, indication, and age group. Changes over time were analyzed with the Cochran-Armitage test for linear trend.
From 1994 to 2003, there were 32,321 hysterectomies performed for benign indications. Hysterectomy rates showed a significant decline, from 4.01 per 1,000 women in 1994 to 3.41 per 1,000 women in 2003 (P for trend < .001). The relative proportions of all hysterectomies performed as laparoscopically assisted vaginal hysterectomy (LAVH) peaked at 13.0% in 1995 and then steadily declined to 3.9% in 2003 (P for trend < .001), whereas the relative proportion of subtotal abdominal hysterectomy increased from 6.9% in 1994 to 20.8% in 2003 (P for trend < .001). Hysterectomy rates declined 11.2% for uterine leiomyoma (relative risk [RR] 0.89, 95% confidence interval [CI] 0.83-0.95), 33.1% for endometriosis (RR 0.67, 95% CI 0.59-0.76), and 18.6% for uterine prolapse (RR 0.81, 95% CI 0.72-0.92). The relative proportion performed for uterine leiomyoma was consistently greater than for all other indications combined.
The rates of hysterectomy for benign indications are decreasing. The type of hysterectomy changed significantly, with LAVH performed less frequently and subtotal abdominal hysterectomy increasing in popularity. Uterine leiomyoma remains the most common indication for benign hysterectomy.
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调查1994年至2003年北加利福尼亚州凯撒医疗集团因良性疾病行子宫切除术的年发生率、类型及指征。
确定1994年至2003年在北加利福尼亚州凯撒医疗集团因良性指征接受子宫切除术的所有20岁及以上女性。我们按类型、指征和年龄组分析了子宫切除率。采用 Cochr an-Armitage线性趋势检验分析随时间的变化。
1994年至2003年，因良性指征共施行子宫切除术32321例。子宫切除率显著下降，从1994年的每1000名女性4.01例降至2003年的每1000名女性3.41例（趋势P值<0.001）。腹腔镜辅助阴式子宫切除术（LAVH）在所有子宫切除术中的相对比例于1995年达到峰值13.0%，随后稳步下降至2003年的3.9%（趋势P值<0.001），而次全腹式子宫切除术的相对比例从1994年的6.9%增至2003年的20.8%（趋势P值<0.001）。子宫肌瘤导致的子宫切除率下降了11.2%（相对危险度[RR]0.89，95%置信区间[CI]0.83 - 0.95），子宫内膜异位症导致的下降了33.1%（RR 0.67，95%CI 0.59 - 0.76），子宫脱垂导致的下降了18.6%（RR 0.81，95%CI 0.72 - 0.92）。子宫肌瘤导致的子宫切除术相对比例始终高于所有其他指征导致的子宫切除术相对比例之和。
因良性指征行子宫切除术的发生率正在下降。子宫切除术的类型发生了显著变化，LAVH施行频率降低，次全腹式子宫切除术越来越受欢迎。子宫肌瘤仍然是良性子宫切除术最常见的指征。
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