Shiber Linda-Dalal J, Gregory Emily J, Gaskins Jeremy T, Biscette Shan M
University of Louisville School of Medicine, Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Louisville, KY 40202, United States.
University of Louisville School of Medicine, Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Louisville, KY 40202, United States.
Eur J Obstet Gynecol Reprod Biol. 2016 May;200:123-7. doi: 10.1016/j.ejogrb.2016.02.043. Epub 2016 Mar 21.
To characterize the etiologies of adnexal masses requiring reoperation in women with prior hysterectomy and to compare incidence and pathology of these masses based upon whether total, partial or no adnexectomy was performed at time of hysterectomy. In addition, the average time interval between hysterectomy and reoperation for a pelvic mass is ascertained.
A single-institution, retrospective review spanning 10 years. Using pertinent ICD-9 and CPT codes, women with a history of hysterectomy who underwent a subsequent surgery for an adnexal or pelvic mass were identified.
Over ten years, 250 women returned for gynecologic surgery due to a pelvic mass after prior hysterectomy. Most had undergone hysterectomy only (76%). 64.8% of these women had masses of ovarian origin, 12.4% were tubal in origin, 20% of masses involved both the ovary and tube and a small proportion arose from non-gynecologic processes. 18% of these women had a malignancy; 80% were ovarian and 6.7% originated from the fallopian tube. Patients having had a prior hysterectomy and bilateral salpingectomy returned soonest (p<0.0001) and patients with malignant masses returned after the longest time intervals (HR 0.41, p<0.0001).
The majority of adnexal masses requiring reoperation after hysterectomy are gynecologic in origin, benign, and arise from the ovary. Women returning with malignant masses after hysterectomy present after longer time intervals.
明确既往接受子宫切除的女性中需要再次手术的附件包块的病因，并根据子宫切除时是否进行了全附件切除术、部分附件切除术或未进行附件切除术，比较这些包块的发生率和病理情况。此外，确定子宫切除与盆腔包块再次手术之间的平均时间间隔。
一项为期10年的单机构回顾性研究。使用相关的国际疾病分类第九版（ICD-9）和现行程序编码（CPT），识别有子宫切除病史且随后因附件或盆腔包块接受手术的女性。
在十年间，250名既往接受子宫切除的女性因盆腔包块返回接受妇科手术。大多数女性仅接受了子宫切除术（76%）。这些女性中64.8%的包块起源于卵巢，12.4%起源于输卵管，20%的包块涉及卵巢和输卵管，一小部分起源于非妇科疾病。这些女性中有18%患有恶性肿瘤；80%为卵巢恶性肿瘤，6.7%起源于输卵管。既往接受子宫切除和双侧输卵管切除术的患者返回时间最早（p<0.0001），患有恶性包块的患者返回时间间隔最长（风险比0.41，p<0.0001）。
子宫切除术后需要再次手术的大多数附件包块起源于妇科，为良性，且起源于卵巢。子宫切除术后因恶性包块返回的女性出现时间间隔较长。
