不同子宫切除术式后阴道残端裂开。
Vaginal cuff dehiscence after different modes of hysterectomy.
机构信息
Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
出版信息
Obstet Gynecol. 2011 Oct;118(4):794-801. doi: 10.1097/AOG.0b013e31822f1c92.
OBJECTIVE
To update the incidence of vaginal cuff dehiscence after different modes of hysterectomy and to describe surgical and patient characteristics of dehiscence complications.
METHODS
This was an observational cohort study at a large academic hospital. All women who underwent hysterectomy and dehiscence repair between January 2006 and December 2009 were identified. Data from this study period were analyzed separately and in combination with our preliminary study (January 2000 to December 2005) for a 10-year analysis (January 2000 to December 2009). The primary outcome was incidence of vaginal cuff dehiscence after total laparoscopic hysterectomy compared with abdominal, vaginal, and laparoscopically assisted vaginal hysterectomy (LAVH).
RESULTS
Between 2006 and 2009, the overall incidence of dehiscence was 0.39% (95% confidence interval [CI] 0.21-0.56). The incidence after total laparoscopic hysterectomy was 0.75% (95% CI 0.09-1.4), which was the highest among all modes of hysterectomy (LAVH was 0.46% [95% CI 0.0-1.10]; total abdominal hysterectomy was 0.38% [95% CI 0.16-0.61]; and total vaginal hysterectomy was 0.11%, [95% CI 0.0-0.32]). This incidence was appreciably lower than previously reported (4.93% in 2007 publication, 2.76% readjusted calculation). The 10-year cumulative incidence of dehiscence after all modes of hysterectomy was 0.24% (95% CI 0.15-0.33) and 1.35% (95% CI 0.72-2.3) among total laparoscopic hysterectomies. During the 10-year study period, total laparoscopic hysterectomy-related dehiscence was significantly increased compared with other modes of hysterectomy, with a risk ratio of dehiscence after total laparoscopic hysterectomy of 9.1 (95% CI 4.1-20.3) compared with total abdominal hysterectomy, risk ratio of 17.2 (95% CI 3.9-75.9) compared with total vaginal hysterectomy, and risk ratio of 4.9 (95% CI 1.1-21.5) compared with LAVH.
CONCLUSION
Our updated 1.35% incidence of dehiscence after total laparoscopic hysterectomy is much lower than previously reported.
LEVEL OF EVIDENCE
II.
目的
更新不同子宫切除术式后阴道残端裂开的发生率，并描述裂开并发症的手术和患者特征。
方法
这是一项在一家大型学术医院进行的观察性队列研究。确定了 2006 年 1 月至 2009 年 12 月期间接受子宫切除术和残端修复的所有女性。对该研究期间的数据进行了单独分析，并与我们的初步研究（2000 年 1 月至 2005 年 12 月）进行了结合，进行了 10 年分析（2000 年 1 月至 2009 年 12 月）。主要结局是全腹腔镜子宫切除术与腹式、阴式和腹腔镜辅助阴式子宫切除术（LAVH）后阴道残端裂开的发生率。
结果
2006 年至 2009 年期间，总的裂开发生率为 0.39%（95%置信区间 [CI] 0.21-0.56）。全腹腔镜子宫切除术的裂开发生率为 0.75%（95% CI 0.09-1.4），是所有子宫切除术式中最高的（LAVH 为 0.46%[95% CI 0.0-1.10]；腹式子宫切除术为 0.38%[95% CI 0.16-0.61]；阴式子宫切除术为 0.11%[95% CI 0.0-0.32]）。这一发生率明显低于先前的报道（2007 年出版物的 4.93%，经重新调整计算后的 2.76%）。所有子宫切除术式 10 年累积的裂开发生率为 0.24%（95% CI 0.15-0.33），全腹腔镜子宫切除术为 1.35%（95% CI 0.72-2.3）。在 10 年研究期间，全腹腔镜子宫切除术相关的裂开明显增加，与其他子宫切除术式相比，全腹腔镜子宫切除术的裂开风险比为 9.1（95% CI 4.1-20.3），与腹式子宫切除术相比，风险比为 17.2（95% CI 3.9-75.9），与阴式子宫切除术相比，风险比为 4.9（95% CI 1.1-21.5），与 LAVH 相比。
结论
我们更新的全腹腔镜子宫切除术 1.35%的裂开发生率明显低于先前的报道。
证据水平
II。
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