Center for Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA.
Am J Obstet Gynecol. 2010 May;202(5):507.e1-4. doi: 10.1016/j.ajog.2010.01.077.
The aim of this study was to assess the risk of unanticipated abnormal gynecologic pathology at the time of reconstructive pelvic surgery to better understand risks of uterine conservation in the surgical treatment of uterovaginal prolapse.
This was a retrospective analysis of pathology findings at hysterectomy with reconstructive pelvic surgery over a 3.5-year period.
Seventeen of 644 patients had unanticipated premalignant or malignant uterine pathology (2.6%; 95% confidence interval, 1.7-4.2). Two (0.3%; 95% confidence interval, 0.09-1.1) had endometrial carcinoma. All cases of unanticipated disease were identified in postmenopausal women.
Premenopausal women with uterovaginal prolapse and normal bleeding patterns or with negative evaluation for abnormal uterine bleeding have a minimal risk of abnormal gynecologic pathology. In postmenopausal women without bleeding, the risk of unanticipated uterine pathology is 2.6% but may be reduced by preoperative endometrial evaluation. However, in women with a history of postmenopausal bleeding, even with a negative endometrial evaluation, we do not recommend uterine preservation at the time of prolapse surgery.
本研究旨在评估重建性骨盆手术时意外出现异常妇科病理的风险，以便更好地了解在治疗子宫阴道脱垂的手术中保留子宫的风险。
这是一项对 3.5 年内接受重建性骨盆手术的子宫切除术的病理发现进行的回顾性分析。
644 例患者中有 17 例（2.6%；95%置信区间，1.7-4.2）出现意外的癌前或恶性子宫病理学。其中 2 例（0.3%；95%置信区间，0.09-1.1）患有子宫内膜癌。所有意外疾病均发生在绝经后妇女中。
绝经前患有子宫阴道脱垂且出血模式正常或经异常子宫出血评估为阴性的妇女，出现异常妇科病理的风险极小。在无出血的绝经后妇女中，意外子宫病理的风险为 2.6%，但术前子宫内膜评估可能会降低这种风险。然而，对于有绝经后出血史的妇女，即使子宫内膜评估为阴性，我们也不建议在脱垂手术时保留子宫。
