Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia 30303, USA.
Obstet Gynecol. 2010 Nov;116(5):1088-95. doi: 10.1097/AOG.0b013e3181f5ec9d.
To examine trends in rates of elective bilateral salpingo-oophorectomy in the United States and to assess the association of perioperative complications with elective bilateral salpingo-oophorectomy.
This cross-sectional study uses 1998-2006 data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project, a nationally representative sample of inpatient hospitalizations. Analyses were limited to women aged 15 years or older at average risk for ovarian cancer who underwent hysterectomy for a benign gynecologic condition. Tests for trends in elective bilateral salpingo-oophorectomy rates were performed using weighted least squares regression for two time periods, 1998 to 2001 and 2002 to 2006. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for risks of complications associated with elective bilateral salpingo-oophorectomy were estimated using logistic regression.
During the period from 1998 to 2006, 39% of the 2,250,041 women who underwent hysterectomy for benign gynecologic indications had elective bilateral salpingo-oophorectomy (rate, 8.3 per 10,000). The elective bilateral salpingo-oophorectomy rate increased from 7.8 per 10,000 in 1998 to 9.0 per 10,000 in 2001 (P trend <.05) and decreased from 9.0 per 10,000 in 2002 to 7.4 per 10,000 in 2006 (P trend <.05). The largest decline from 2002 to 2006 (20.3%) occurred among those aged 45 to 49 years. Compared with hysterectomy only, elective bilateral salpingo-oophorectomy was associated with an increased risk of complications when performed vaginally (OR 1.12; 95% CI 1.08-1.17) and a decreased risk of complications when performed abdominally (OR 0.91; 95% CI 0.89-0.94) or laparoscopically (OR 0.89; 95% CI 0.83-0.94).
Elective bilateral salpingo-oophorectomy rates declined since 2002. However, the risks compared with the benefits of the procedure have not been clearly established. Prospective studies examining elective bilateral salpingo-oophorectomy with and without estrogen therapy are needed to guide practice patterns.
III.
在美国，研究择期双侧输卵管卵巢切除术的比率趋势，并评估围手术期并发症与择期双侧输卵管卵巢切除术的关联。
本横断面研究使用了医疗费用和利用项目国家住院患者样本 1998-2006 年的数据，该数据为全国代表性的住院患者样本。分析仅限于年龄在 15 岁或以上、平均存在卵巢癌风险且因良性妇科疾病接受子宫切除术的女性。使用加权最小二乘回归对两个时间段（1998 年至 2001 年和 2002 年至 2006 年）的择期双侧输卵管卵巢切除术的比率进行趋势检验。使用逻辑回归估计与择期双侧输卵管卵巢切除术相关的并发症风险的调整比值比（OR）和 95%置信区间（CI）。
在 1998 年至 2006 年期间，225 万因良性妇科指征接受子宫切除术的女性中，有 39%（83000 例）接受了择期双侧输卵管卵巢切除术（比率为 8.3/10000）。择期双侧输卵管卵巢切除术的比率从 1998 年的 7.8/10000 上升到 2001 年的 9.0/10000（P趋势<.05），并从 2002 年的 9.0/10000 下降到 2006 年的 7.4/10000（P趋势<.05）。从 2002 年到 2006 年，下降幅度最大的是 45 至 49 岁的人群（20.3%）。与仅行子宫切除术相比，经阴道行择期双侧输卵管卵巢切除术与并发症风险增加相关（OR 1.12；95%CI 1.08-1.17），而经腹（OR 0.91；95%CI 0.89-0.94）或腹腔镜（OR 0.89；95%CI 0.83-0.94）行该手术则与并发症风险降低相关。
自 2002 年以来，择期双侧输卵管卵巢切除术的比率有所下降。然而，与该手术相关的风险与益处尚未明确确定。需要进行前瞻性研究，以评估有无雌激素治疗的择期双侧输卵管卵巢切除术，并以此来指导实践模式。
III 级。
