Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina.
Obstet Gynecol. 2013 Mar;121(3):654-673. doi: 10.1097/AOG.0b013e3182841594.
Hysterectomy is the most common gynecologic procedure performed in the United States, with more than 600,000 procedures performed each year. Complications of hysterectomy vary based on route of surgery and surgical technique. The objective of this article is to review risk factors associated with specific types of complications associated with benign hysterectomy, methods to prevent and recognize complications, and appropriate management of complications. The most common complications of hysterectomy can be categorized as infectious, venous thromboembolic, genitourinary (GU) and gastrointestinal (GI) tract injury, bleeding, nerve injury, and vaginal cuff dehiscence. Infectious complications after hysterectomy are most common, ranging from 10.5% for abdominal hysterectomy to 13.0% for vaginal hysterectomy and 9.0% for laparoscopic hysterectomy. Venous thromboembolism is less common, ranging from a clinical diagnosis rate of 1% to events detected by more sensitive laboratory methods of up to 12%. Injury to the GU tract is estimated to occur at a rate of 1-2% for all major gynecologic surgeries, with 75% of these injuries occurring during hysterectomy. Injury to the GI tract after hysterectomy is less common, with a range of 0.1-1%. Bleeding complications after hysterectomy also are rare, with a median range of estimated blood loss of 238-660.5 mL for abdominal hysterectomy, 156-568 mL for laparoscopic hysterectomy, and 215-287 mL for vaginal hysterectomy, with transfusion only being more likely after laparoscopic compared to vaginal hysterectomy (odds ratio 2.07, confidence interval 1.12-3.81). Neuropathy after hysterectomy is a rare but significant event, with a rate of 0.2-2% after major pelvic surgery. Vaginal cuff dehiscence is estimated at a rate of 0.39%, and it is more common after total laparoscopic hysterectomy (1.35%) compared with laparoscopic-assisted vaginal hysterectomy (0.28%), total abdominal hysterectomy (0.15%), and total vaginal hysterectomy (0.08%). With an emphasis on optimizing surgical technique, recognition of surgical complications, and timely management, we aim to minimize risk for women undergoing hysterectomy.
子宫切除术是美国最常见的妇科手术，每年有超过 600,000 例手术。子宫切除术的并发症因手术途径和手术技术而异。本文的目的是回顾与良性子宫切除术相关的特定类型并发症的危险因素，预防和识别并发症的方法，以及并发症的适当处理。子宫切除术最常见的并发症可分为感染、静脉血栓栓塞、泌尿生殖系统（GU）和胃肠道（GI）tract 损伤、出血、神经损伤和阴道残端裂开。子宫切除术后的感染性并发症最为常见，从腹部子宫切除术的 10.5%到阴道子宫切除术的 13.0%和腹腔镜子宫切除术的 9.0%不等。静脉血栓栓塞症较少见，从临床诊断率 1%到更敏感的实验室方法检测到的发生率高达 12%不等。GU tract 损伤估计在所有主要妇科手术中的发生率为 1-2%，其中 75%的损伤发生在子宫切除术中。子宫切除术后 GI tract 损伤较少见，范围为 0.1-1%。子宫切除术后出血并发症也很少见，腹部子宫切除术的估计失血量中位数范围为 238-660.5mL，腹腔镜子宫切除术为 156-568mL，阴道子宫切除术为 215-287mL，只有腹腔镜子宫切除术比阴道子宫切除术更有可能输血（比值比 2.07，置信区间 1.12-3.81）。子宫切除术后神经病变是一种罕见但严重的事件，在主要盆腔手术后的发生率为 0.2-2%。阴道残端裂开的估计发生率为 0.39%，在全腹腔镜子宫切除术（1.35%）中比腹腔镜辅助阴道子宫切除术（0.28%）、全腹部子宫切除术（0.15%）和全阴道子宫切除术（0.08%）更常见。我们强调优化手术技术、识别手术并发症和及时处理，旨在最大限度地降低接受子宫切除术的女性的风险。
