Denman Mary Anna, Gregory W Thomas, Boyles Sarah H, Smith Virginia, Edwards S Renee, Clark Amanda L
Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA.
Am J Obstet Gynecol. 2008 May;198(5):555.e1-5. doi: 10.1016/j.ajog.2008.01.051. Epub 2008 Mar 20.
This study measured the 10-year risk of reoperation for surgically treated pelvic organ prolapse and urinary incontinence (POPUI) in a community population.
We conducted a prospective cohort analysis of 374 women who were > 20 years old and who underwent surgery for POPUI in 1995.
The 10-year reoperation rate was 17% by Kaplan Meier analysis. Previous POPUI surgery at the time of index surgery conferred a hazard ratio of 1.9 (95% CI, 1.1-3.2; P = .018). The abdominal approach was protective against reoperation compared with the vaginal approach (hazard ratio, 0.37; 95% CI, 0.17-0.83; P = .02) With the use of Cox regression, no association was observed for age, vaginal parity, previous hysterectomy, body mass index, prolapse severity, ethnicity, chronic lung disease, smoking, estrogen status, surgical indication, or anatomic compartment.
A reoperation rate of 17% is unacceptably high and likely represents an underestimate of the true rate. Most of the factors that influence reoperation have not yet been identified.
本研究测量了社区人群中接受手术治疗的盆腔器官脱垂和尿失禁（POPUI）患者再次手术的10年风险。
我们对1995年接受POPUI手术的374名年龄大于20岁的女性进行了前瞻性队列分析。
通过Kaplan Meier分析，10年再次手术率为17%。初次手术时曾接受过POPUI手术，风险比为1.9（95%可信区间，1.1 - 3.2；P = .018）。与经阴道手术相比，经腹手术对再次手术有保护作用（风险比，0.37；95%可信区间，0.17 - 0.83；P = .02）。使用Cox回归分析，未观察到年龄、阴道分娩次数、既往子宫切除术、体重指数、脱垂严重程度、种族、慢性肺病、吸烟、雌激素状态、手术指征或解剖部位与再次手术之间存在关联。
17%的再次手术率高得令人难以接受，且可能低估了实际发生率。大多数影响再次手术的因素尚未明确。
