Duong Thinh H, Patterson Tamula M
Emory University School of Medicine, Department of Gynecology and Obstetrics, Division of Female Pelvic Medicine and Reconstructive Surgery, Atlanta, GA, USA,
Int Urogynecol J. 2014 Aug;25(8):1037-40. doi: 10.1007/s00192-013-2324-3. Epub 2014 Feb 13.
To evaluate lower urinary tract injuries in women with ≥2 prior cesarean deliveries (CD) undergoing benign hysterectomies.
This is a planned secondary analysis of all hysterectomies performed from 2000 to 2009 at Grady Memorial Hospital. Demographic, operative and postoperative data were reviewed. Women undergoing benign hysterectomies with ≥2 CD were compared with women with no prior CD. Categorical variables were analyzed using Chi-squared or Fisher's exact test, while Student's t test was used for continuous variables. Logistic regression was used for multivariate analysis.
2,214 women met the inclusion criteria (284 with ≥2 CD, 1,930 with no CD). The proportion of women having vaginal hysterectomy, abdominal hysterectomy, and laparoscopically assisted vaginal hysterectomy were 38%, 53%, and 9% respectively. Women with multiple CD had greater blood loss and longer operative times. They also required more transfusions (23% vs 15%, P = 0.001) and developed more abdominal wounds (6% vs 3%, P = 0.002) or urinary infections (6% vs 3%, P = 0.03). Women with ≥2 CD were at greater risk of incidental cystotomies (OR: 8.55, 95% CI: 3.98-18.36).
Multiple prior cesarean deliveries increase a woman's risk of cystotomy during hysterectomy. They also require more transfusions and develop more urinary or abdominal wound infections.
评估既往有≥2次剖宫产史且接受良性子宫切除术的女性的下尿路损伤情况。
这是对2000年至2009年在格雷迪纪念医院进行的所有子宫切除术的一项计划中的二次分析。回顾了人口统计学、手术及术后数据。将既往有≥2次剖宫产史且接受良性子宫切除术的女性与无既往剖宫产史的女性进行比较。分类变量采用卡方检验或Fisher精确检验进行分析，连续变量采用学生t检验。多因素分析采用逻辑回归。
2214名女性符合纳入标准（284名有≥2次剖宫产史，1930名无剖宫产史）。接受阴道子宫切除术、腹式子宫切除术和腹腔镜辅助阴道子宫切除术的女性比例分别为38%、53%和9%。有多次剖宫产史的女性失血量更多，手术时间更长。她们还需要更多输血（23%对15%，P = 0.001），发生更多腹部伤口（6%对3%，P = 0.002）或泌尿系统感染（6%对3%，P = 0.03）。有≥2次剖宫产史的女性发生意外膀胱切开术的风险更高（比值比：8.55，95%置信区间：3.98 - 18.36）。
既往多次剖宫产会增加女性在子宫切除术中发生膀胱切开术的风险。她们还需要更多输血，发生更多泌尿系统或腹部伤口感染。
