From the University of California, San Francisco, Department of Obstetrics, Gynecology, and Reproductive Sciences, and the Department of Obstetrics and Gynecology, Kaiser Permanente Northern California, San Francisco, California.
Obstet Gynecol. 2009 Nov;114(5):1041-1048. doi: 10.1097/AOG.0b013e3181b9d222.
To examine factors associated with undergoing laparoscopic hysterectomy compared with abdominal hysterectomy or vaginal hysterectomy.
This is a cross-sectional analysis of the 2005 Nationwide Inpatient Sample. All women aged 18 years or older who underwent hysterectomy for a benign condition were included. Multivariable analyses were used to examine demographic, clinical, and health-system factors associated with each hysterectomy route.
Among 518,828 hysterectomies, 14% were laparoscopic, 64% abdominal, and 22% vaginal. Women older than 35 years had lower rates of laparoscopic than abdominal (odds ratio [OR] 0.85, 95% confidence interval [CI] 0.77-0.94 for age 45-49 years) or vaginal hysterectomy (OR 0.61, 95% CI 0.540.69 for age 45-49 years). The odds of laparoscopic compared with abdominal hysterectomy were higher in the West than in the Northeast (OR 1.77, 95% CI 1.2-2.62). African-American, Latina, and Asian women had 40-50% lower odds of laparoscopic compared with abdominal hysterectomy (P<.001). Women with low income, Medicare, Medicaid, or no health insurance were less likely to undergo laparoscopic than either vaginal or abdominal hysterectomy (P<.001). Women with leiomyomas (P<.001) and pelvic infections (P<.001) were less likely to undergo laparoscopic than abdominal hysterectomy. Women with leiomyomas (P<.001), endometriosis (P<.001), or pelvic infections (P<.001) were more likely to have laparoscopic than vaginal hysterectomy. Laparoscopic hysterectomy had the highest mean hospital charges ($18,821, P<.001) and shortest length of stay (1.65 days, P<.001).
In addition to age and clinical diagnosis, nonclinical factors such as race/ethnicity, insurance status, income, and region appear to affect use of laparoscopic hysterectomy compared with abdominal hysterectomy and vaginal hysterectomy.
III.
研究与经腹子宫切除术或经阴道子宫切除术相比，行腹腔镜子宫切除术的相关因素。
这是对 2005 年全国住院患者样本的横断面分析。所有年龄在 18 岁及以上因良性疾病行子宫切除术的女性均纳入研究。多变量分析用于研究与每种子宫切除术途径相关的人口统计学、临床和医疗系统因素。
在 518828 例子宫切除术中，14%为腹腔镜，64%为经腹，22%为经阴道。年龄超过 35 岁的女性行腹腔镜手术的比例低于经腹（年龄 45-49 岁时，比值比 [OR] 0.85，95%置信区间 [CI] 0.77-0.94）或经阴道子宫切除术（OR 0.61，95%CI 0.54-0.69）。与经腹子宫切除术相比，西部地区行腹腔镜手术的可能性高于东北地区（OR 1.77，95%CI 1.2-2.62）。非裔美国女性、拉丁裔女性和亚裔女性行腹腔镜手术的可能性比经腹子宫切除术低 40-50%（P<.001）。收入较低、接受医疗保险、医疗补助或没有健康保险的女性行腹腔镜手术的可能性低于经阴道或经腹子宫切除术（P<.001）。患有子宫肌瘤（P<.001）和盆腔感染（P<.001）的女性行腹腔镜手术的可能性低于经腹子宫切除术。患有子宫肌瘤（P<.001）、子宫内膜异位症（P<.001）或盆腔感染（P<.001）的女性行腹腔镜手术的可能性高于经阴道子宫切除术。腹腔镜子宫切除术的平均住院费用最高（$18821，P<.001），住院时间最短（1.65 天，P<.001）。
除了年龄和临床诊断外，种族/民族、保险状况、收入和地区等非临床因素似乎也会影响与经腹子宫切除术和经阴道子宫切除术相比，腹腔镜子宫切除术的应用。
III 级。
