阴道子宫切除术与盆腔器官脱垂及压力性尿失禁手术风险
Vaginal hysterectomy and risk of pelvic organ prolapse and stress urinary incontinence surgery.
作者信息
Forsgren Catharina, Lundholm Cecilia, Johansson Anna L V, Cnattingius Sven, Zetterström Jan, Altman Daniel
机构信息
Division of Obstetrics and Gynecology, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden.
出版信息
Int Urogynecol J. 2012 Jan;23(1):43-8. doi: 10.1007/s00192-011-1523-z. Epub 2011 Aug 18.
INTRODUCTION AND HYPOTHESIS
This study aims to determine the risk of pelvic organ prolapse (POP) and stress urinary incontinence (SUI) surgery related to mode of hysterectomy focusing on vaginal hysterectomy.
METHODS
We performed a nationwide cohort study. Women exposed to hysterectomy on benign indications (n = 118,601) were compared to women unexposed to hysterectomy (n = 579,200). The outcome was defined as first occurrence of POP or SUI surgery. Hazard ratios (HRs) were calculated with 95% confidence intervals (CIs) using Cox proportional-hazards models.
RESULTS
The greatest risks of POP (HR 4.9, 95% CI 3.4-6.9) or SUI surgery (HR 6.3, 95% CI 4.4-9.1) were observed subsequent to vaginal hysterectomy for pelvic organ prolapse. Having a vaginal hysterectomy for other reasons also significantly increased the risks of POP and SUI surgery compared to other modes of hysterectomy.
CONCLUSIONS
Hysterectomy in general, in particular vaginal hysterectomy, was associated with an increased risk for subsequent POP and SUI surgery.
引言与假设
本研究旨在确定与子宫切除术方式相关的盆腔器官脱垂（POP）和压力性尿失禁（SUI）手术风险，重点关注经阴道子宫切除术。
方法
我们开展了一项全国性队列研究。将因良性指征接受子宫切除术的女性（n = 118,601）与未接受子宫切除术的女性（n = 579,200）进行比较。结局定义为首次发生POP或SUI手术。使用Cox比例风险模型计算风险比（HRs）及95%置信区间（CIs）。
结果
在因盆腔器官脱垂行经阴道子宫切除术后，观察到POP（HR 4.9，95% CI 3.4 - 6.9）或SUI手术（HR 6.3，95% CI 4.4 - 9.1）的最大风险。与其他子宫切除术方式相比，因其他原因行经阴道子宫切除术也显著增加了POP和SUI手术的风险。
结论
总体而言，子宫切除术，尤其是经阴道子宫切除术，与后续POP和SUI手术风险增加相关。
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