Wasson Megan, Butler Kristina, Magtibay Paul, Temkit M'hamed, Magrina Javier
Department of Gynecologic Surgery and the Division of Health Sciences Research, Mayo Clinic Arizona, Phoenix, Arizona.
Obstet Gynecol. 2016 Apr;127(4):752-757. doi: 10.1097/AOG.0000000000001346.
To determine prognostic factors associated with cold-knife morcellation during vaginal hysterectomy.
We conducted a retrospective cohort study evaluating all consecutive patients undergoing a vaginal hysterectomy between January 1, 2009, and August 31, 2014. The primary outcome was the utilization of uncontained vaginal morcellation performed using cold-knife wedge resection at the time of vaginal hysterectomy. Secondary outcomes included perioperative data. Significant factors were included in a multivariate logistic regression model to the binary variable vaginal morcellation at the time of vaginal hysterectomy.
A total of 743 women met study inclusion criteria and underwent vaginal hysterectomy with intact uterine removal (n=383) or with uterine morcellation (n=360) with and without other vaginal procedures. A nonparametric Wilcoxon-rank-sum test and χ test were used to compare the cohorts of patients with and without morcellation. Characteristics associated with significantly increased likelihood of morcellation included younger age, non-Caucasian race, American Society of Anesthesiologists class 1 or 2, lower parity, lower number of prior vaginal deliveries, absence of prolapse, presence of leiomyoma, and an enlarged uterus. A multivariate logistic model utilizing factors most likely associated with morcellation revealed lack of prolapse (adjusted odds ratio [OR] 3.87, P<.001), leiomyoma (adjusted OR 2.77, P=.035), and larger uterine weight (adjusted OR 7.25, P<.001) increased the likelihood of morcellation. Prior vaginal delivery was associated with a decreased likelihood of morcellation (adjusted OR 0.79, P=.005).
Vaginal hysterectomy with morcellation is associated with the following factors: absence of prior vaginal delivery, absence of prolapse, presence of leiomyoma, and a uterus larger than normal size.
确定与经阴道子宫切除术中冷刀旋切相关的预后因素。
我们进行了一项回顾性队列研究，评估了2009年1月1日至2014年8月31日期间所有连续接受经阴道子宫切除术的患者。主要结局是在经阴道子宫切除术时使用冷刀楔形切除术进行的未封闭阴道旋切的应用情况。次要结局包括围手术期数据。将显著因素纳入多变量逻辑回归模型，以分析经阴道子宫切除术时阴道旋切这一二元变量。
共有743名女性符合研究纳入标准，接受了完整子宫切除术（n = 383）或子宫旋切术（n = 360），其中部分患者还接受了其他阴道手术。采用非参数Wilcoxon秩和检验和χ检验比较有旋切和无旋切患者队列。与旋切可能性显著增加相关的特征包括年龄较小、非白种人、美国麻醉医师协会分级为1或2级、低产次、既往阴道分娩次数较少、无脱垂、存在平滑肌瘤以及子宫增大。利用最可能与旋切相关的因素建立的多变量逻辑模型显示，无脱垂（调整优势比[OR] 3.87，P <.001）、平滑肌瘤（调整OR 2.77，P =.035）和子宫重量较大（调整OR 7.25，P <.001）会增加旋切的可能性。既往阴道分娩与旋切可能性降低相关（调整OR 0.79，P =.005）。
经阴道子宫切除术联合旋切与以下因素相关：既往无阴道分娩、无脱垂、存在平滑肌瘤以及子宫大于正常大小。
