Perkins Rebecca B, Handal-Orefice Roxane, Hanchate Amresh D, Lin Mengyun, Paasche-Orlow Michael K
Boston Medical Center Place, Boston University Medical Center, Boston University School of Medicine, Boston, Massachusetts.
Boston Medical Center Place, Boston University Medical Center, Boston University School of Medicine, Boston, Massachusetts.
Womens Health Issues. 2016 Jan-Feb;26(1):21-6. doi: 10.1016/j.whi.2015.09.008. Epub 2015 Nov 19.
Power morcellation during gynecological procedures may cause seeding of undiagnosed cancers. We used a national database to determine the prevalence of malignant and premalignant conditions that were present but undetected at the time of laparoscopic supracervical hysterectomy and laparoscopic myomectomy, surgeries in which morcellation is commonly used.
Data from 2007 to 2012 were obtained from MarketScan, an administrative database of diagnostic and treatment data for 55.7 million commercially insured women in the United States. Because power morcellation is not captured with billing codes, we limited our analysis to women undergoing procedures that typically use morcellation and that are contraindicated in the case of suspected malignancy to describe the rates at which undetected cancers occur, thus potentially putting patients at risk for seeding of malignant tissue. We defined the rate of preoperative endometrial biopsy and postoperative cancers and hyperplasia by manually reviewing inpatient and outpatient International Classification of Disease, 9th edition, and Current Procedural Terminology codes for all suspected cases.
In all, 17,903 women underwent laparoscopic supracervical hysterectomy and 1,603 underwent laparoscopic myomectomy. The rate of uterine cancer among women undergoing hysterectomy was 2.96 per 1000 and increased with age from 0 per 1,000 at age younger than 35 to 9.07 per 1,000 at ages 55 to 64 (p < .05 for age ≥45 compared with <45). Preoperative endometrial biopsy was documented in 47% of women subsequently diagnosed with uterine cancer. The overall rate of malignant and premalignant gynecological conditions was 5.14 per 1,000 for laparoscopic supracervical hysterectomy and 1.87 per 1,000 for laparoscopic myomectomy.
Approximately 1 in 350 women undergoing laparoscopic supracervical hysterectomy had an undiagnosed uterine cancer, with higher risks among older women. Approximately one-half of women had endometrial biopsies documented before hysterectomy. Safer alternatives, such as contained morcellation, should be evaluated to reduce the risk of complications after morcellation procedures.
妇科手术中的动力粉碎术可能导致未诊断癌症的种植。我们使用一个全国性数据库来确定在腹腔镜次全子宫切除术和腹腔镜子宫肌瘤切除术中存在但未被检测到的恶性和癌前病变的患病率，这两种手术通常会使用动力粉碎术。
2007年至2012年的数据来自MarketScan，这是一个针对美国5570万商业保险女性的诊断和治疗数据的管理数据库。由于动力粉碎术未通过计费代码记录，我们将分析限于接受通常使用动力粉碎术且在怀疑恶性肿瘤时禁忌的手术的女性，以描述未被检测到的癌症的发生率，从而可能使患者面临恶性组织种植的风险。我们通过手动查阅所有疑似病例的住院和门诊国际疾病分类第九版及当前程序术语代码来确定术前子宫内膜活检率以及术后癌症和增生率。
共有17903名女性接受了腹腔镜次全子宫切除术，1603名女性接受了腹腔镜子宫肌瘤切除术。接受子宫切除术的女性中子宫癌的发生率为每1000人中有2.96例，并且随着年龄增长而增加，从35岁以下的每1000人中有0例增加到55至64岁的每1000人中有9.07例（年龄≥45岁与＜45岁相比，p＜0.05）。在随后被诊断为子宫癌的女性中，有47%记录了术前子宫内膜活检。腹腔镜次全子宫切除术的恶性和癌前妇科疾病总体发生率为每千例中有5.14例，腹腔镜子宫肌瘤切除术为每千例中有1.87例。
接受腹腔镜次全子宫切除术的女性中约每350人中有1人患有未被诊断的子宫癌，老年女性风险更高。约一半的女性在子宫切除术前行子宫内膜活检记录。应评估更安全的替代方法，如封闭粉碎术，以降低粉碎术操作后的并发症风险。
