Dain Lena, Abramov Yoram
Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel.
Aust N Z J Obstet Gynaecol. 2011 Aug;51(4):307-9. doi: 10.1111/j.1479-828X.2011.01323.x. Epub 2011 Jun 9.
About 15% of all hysterectomies are performed for pelvic organ prolapse, generally through the transvaginal approach. However, concomitant bilateral salpingo-oophorectomy (BSO) is not always feasible through this approach, because the adnexae are sometimes inaccessible.
To identify factors affecting the feasibility of performing BSO during transvaginal hysterectomy for uterine prolapse.
We reviewed charts of all women undergoing vaginal hysterectomy for uterine prolapse in our institution between December 2005 and November 2009, at which time BSO was uniformly attempted in all patients.
One hundred and seventy-two women who underwent vaginal hysterectomy were identified, of whom 134 (78%) underwent concomitant BSO. Women in whom BSO was feasible were younger (60.6±10.1 vs 65.6±8.6 years, P<0.02) and had a higher prevalence of advanced prolapse, including stage IV cystocele (68% vs 38%, P=0.01), stage III-IV rectocele (40% vs 11%, P=0.003) and stage IV uterine prolapse (64% vs 25%, P=0.0005).
The feasibility of BSO was primarily dependent on the stage of pelvic organ prolapse and patients' age. Relaxation of the adnexae because of weakness of the infundibulo-pelvic ligaments may accompany severe pelvic organ prolapse and may potentially explain the feasibility of BSO in these women.
所有子宫切除术中约15%是因盆腔器官脱垂而进行的，通常采用经阴道途径。然而，经此途径同时行双侧输卵管卵巢切除术（BSO）并不总是可行的，因为附件有时难以触及。
确定影响子宫脱垂经阴道子宫切除术时行BSO可行性的因素。
我们回顾了2005年12月至2009年11月在我院因子宫脱垂接受阴道子宫切除术的所有女性的病历，当时所有患者均统一尝试行BSO。
确定了172例行阴道子宫切除术的女性，其中134例（78%）同时行BSO。可行BSO的女性更年轻（60.6±10.1岁对65.6±8.6岁，P<0.02），且高级别脱垂的患病率更高，包括IV度膀胱膨出（68%对38%，P=0.01）、III-IV度直肠膨出（40%对11%，P=0.003）和IV度子宫脱垂（64%对25%，P=0.0005）。
BSO的可行性主要取决于盆腔器官脱垂的程度和患者年龄。严重盆腔器官脱垂可能伴有因漏斗骨盆韧带松弛导致的附件松弛，这可能解释了在这些女性中行BSO的可行性。
