Forsgren Catharina, Lundholm Cecilia, Johansson Anna L V, Cnattingius Sven, Altman Daniel
From the Department of Medical Epidemiology and Biostatistics, the Division of Obstetrics and Gynecology, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital; and Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Obstet Gynecol. 2009 Sep;114(3):594-599. doi: 10.1097/AOG.0b013e3181b2a1df.
To study the association between hysterectomy for benign indications and pelvic organ fistula disease.
We conducted a nationwide cohort study based on Swedish health care registers. The cohort consisted of 182,641 women having hysterectomy (exposed cohort) and 525,826 women not undergoing the procedure (unexposed cohort) from the Swedish Inpatient Register 1973-2003. The outcome was defined as surgery for pelvic organ fistula disease. We calculated incidence rates for fistula disease and hazard ratios (HRs) with 95% confidence intervals (CIs) as a measure of relative risk.
We identified 853 cases of pelvic organ fistula surgery: 469 among the exposed women and 384 among the unexposed. The overall rate of fistula surgery was four times higher in the exposed compared with the unexposed cohort (rate 23.8 and 6.3 per 100,000 person-years, respectively). Overall number needed to harm was 5,700. Compared with unexposed, the risk for fistula disease was more than 20 times higher the first year after surgery (HR 21.2, 95% CI 14.9-30.2). The most common type of fistula was intestinogenital fistula (404 cases, 47%), followed by urogenital fistula (220 cases, 26%). Laparoscopic hysterectomy was associated with the highest rate of fistula surgery, and subtotal abdominal hysterectomy was associated with the lowest (rate 95.9 and 13.7 per 100,000 person-years, respectively).
Pelvic organ fistula surgery is four times more common in women after hysterectomy compared with women not having the procedure. The highest fistula rates were observed the first year after surgery, after laparoscopic and total abdominal hysterectomy, and among older women.
II.
研究因良性指征行子宫切除术与盆腔器官瘘疾病之间的关联。
我们基于瑞典医疗保健登记系统进行了一项全国性队列研究。该队列由1973年至2003年瑞典住院患者登记系统中182,641例行子宫切除术的女性（暴露队列）和525,826例未接受该手术的女性（未暴露队列）组成。结局定义为盆腔器官瘘疾病的手术治疗。我们计算了瘘疾病的发病率和风险比（HRs）以及95%置信区间（CIs）作为相对风险的衡量指标。
我们确定了853例盆腔器官瘘手术病例：暴露女性中有469例，未暴露女性中有384例。与未暴露队列相比，暴露队列中瘘手术的总体发生率高出四倍（发生率分别为每10万人年23.8例和6.3例）。总体伤害所需人数为5700。与未暴露者相比，术后第一年瘘疾病的风险高出20倍以上（HR 21.2，95% CI 14.9 - 30.2）。最常见的瘘类型是肠生殖瘘（404例，47%），其次是泌尿生殖瘘（220例，26%）。腹腔镜子宫切除术与瘘手术的最高发生率相关，次全腹式子宫切除术与最低发生率相关（发生率分别为每10万人年95.9例和13.7例）。
与未行子宫切除术的女性相比，子宫切除术后女性盆腔器官瘘手术的发生率高出四倍。术后第一年、腹腔镜和全腹式子宫切除术后以及老年女性中观察到最高的瘘发生率。
II级。
