Division of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio, Texas; and the Divisions of Gynecologic Surgery, Gastroenterology and Hepatology, Biomedical Statistics and Informatics, and Epidemiology, Mayo Clinic, Rochester, Minnesota.
Obstet Gynecol. 2013 May;121(5):1069-1074. doi: 10.1097/AOG.0b013e31828e89df.
To compare the risk of subsequent oophorectomy among women who underwent hysterectomy for benign indications and those who did not.
Using Rochester Epidemiology Project resources, we compared the risk of oophorectomy through December 31, 2008, among 4,931 women in Olmsted County, Minnesota, who underwent ovary-sparing hysterectomy for benign indications (case group) between 1965 and 2002, with 4,931 age-matched women who did not undergo hysterectomy (referent group). The cumulative incidence of subsequent oophorectomy was estimated by the Kaplan-Meier method, and comparisons were evaluated by Cox proportional hazard models using age as the time scale to allow for complete age adjustment.
The median follow-up times for case group and referent group participants were 19.6 and 19.4 years, respectively. At 10, 20, and 30 years after hysterectomy, the respective cumulative incidences of subsequent oophorectomy were 3.5%, 6.2%, and 9.2% among case group participants and 1.9%, 4.8%, and 7.3% among referent group participants. The overall risk of subsequent oophorectomy among case group participants was significantly higher than among referent group participants (hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.02-1.42; P=.03). Furthermore, among case group participants, the risk of subsequent oophorectomy was significantly higher (HR 2.15, 95% CI 1.51-3.07; P<.001) in women who had both ovaries preserved compared with those who initially had one ovary preserved.
The incidence of oophorectomy after hysterectomy is only 9.2% at 30-year follow-up and is only 1.9 percentage points higher than the incidence of oophorectomy in referent women with intact reproductive organs.
II.
比较因良性指征行子宫切除术的女性与未行子宫切除术的女性后续行卵巢切除术的风险。
利用罗切斯特流行病学项目资源，我们比较了 1965 年至 2002 年间明尼苏达州奥姆斯特德县 4931 例因良性指征行卵巢保留子宫切除术的女性（病例组）与 4931 例年龄匹配未行子宫切除术的女性（对照组）截至 2008 年 12 月 31 日行卵巢切除术的风险。采用 Kaplan-Meier 法估计随后卵巢切除术的累积发生率，并采用 Cox 比例风险模型进行比较，以年龄为时间尺度进行完全年龄调整。
病例组和对照组参与者的中位随访时间分别为 19.6 年和 19.4 年。在子宫切除术 10、20 和 30 年后，病例组参与者随后卵巢切除术的累积发生率分别为 3.5%、6.2%和 9.2%，对照组参与者分别为 1.9%、4.8%和 7.3%。病例组参与者随后卵巢切除术的总体风险明显高于对照组参与者（风险比 [HR] 1.20，95%置信区间 [CI] 1.02-1.42；P=.03）。此外，在病例组参与者中，与最初保留一侧卵巢的女性相比，同时保留双侧卵巢的女性随后行卵巢切除术的风险明显更高（HR 2.15，95% CI 1.51-3.07；P<.001）。
在 30 年随访时，子宫切除术后卵巢切除术的发生率仅为 9.2%，比保留完整生殖器官的对照组女性的卵巢切除术发生率仅高 1.9 个百分点。
II。
