Gimbel Helga
Departments of Obstetrics and Gynecology, Hillerød Hospital, Hillerød, Denmark.
Acta Obstet Gynecol Scand. 2007;86(2):133-44. doi: 10.1080/00016340601024716.
Total and subtotal abdominal hysterectomy for benign indications have been compared in randomized clinical trials and observational studies. A meta-analysis is performed to summarize the evidence.
Thirty-four randomized clinical trials and observational studies comparing total and subtotal abdominal hysterectomy for benign indications were included. Endpoints were self-reported urinary incontinence, postoperative complications, operation time, quality of life, constipation, prolapse, sexual functioning, pelvic pain, and cervical stump problems after subtotal hysterectomy. Odds ratios and tests for heterogeneity and overall effect were calculated.
Urinary incontinence and prolapse showed a significant difference favoring the total hysterectomy. Some of the women having a subtotal hysterectomy had cervical stump problems (bleeding and abnormal smear). Operation time and peroperative bleeding are postoperative complications were significantly in favor of the subtotal hysterectomy. Lower urinary tract symptoms other than incontinence, quality of life, constipation, pelvic pain, and sexual life were not in favor of either of the hysterectomy methods.
Less women suffered from urinary incontinence and prolapse and cervical stump problems after total than after subtotal hysterectomy. However, subtotal hysterectomy is faster to perform, has less peroperative bleeding, and seems to have less intra- and postoperative complications.
在随机临床试验和观察性研究中，已对因良性指征行全腹子宫切除术和次全腹子宫切除术进行了比较。现进行一项荟萃分析以总结相关证据。
纳入34项比较因良性指征行全腹子宫切除术和次全腹子宫切除术的随机临床试验和观察性研究。终点指标包括自我报告的尿失禁、术后并发症、手术时间、生活质量、便秘、脱垂、性功能、盆腔疼痛以及次全子宫切除术后的宫颈残端问题。计算比值比以及异质性检验和总体效应。
尿失禁和脱垂方面，全子宫切除术显示出显著优势。部分接受次全子宫切除术的女性出现宫颈残端问题（出血和涂片异常）。手术时间和术中出血以及术后并发症方面，次全子宫切除术明显更具优势。除尿失禁外的下尿路症状、生活质量、便秘、盆腔疼痛和性生活方面，两种子宫切除方法均无优势。
与次全子宫切除术后相比，全子宫切除术后尿失禁、脱垂和宫颈残端问题的女性患者较少。然而，次全子宫切除术操作更快，术中出血更少，且似乎术中和术后并发症也更少。
