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[法国预防性和机会性输卵管切除术的当前外科手术实践]

[Current surgical practice of prophylactic and opportunistic salpingectomy in France].

作者信息

Chene G, de Rochambeau B, Le Bail-Carval K, Beaufils E, Chabert P, Mellier G, Lamblin G

机构信息

Département de gynécologie, hôpital Femme-Mère-Enfant (HFME), hospices civils de Lyon, 69000 Lyon, France; EMR 3738, université Claude-Bernard Lyon 1, 69000 Lyon, France.

Département de gynécologie-obstétrique, hôpital privé Marne-Chantereine, 77177 Brou-sur-Chantereine, France.

出版信息

Gynecol Obstet Fertil. 2016 Jul-Aug;44(7-8):377-84. doi: 10.1016/j.gyobfe.2016.05.003. Epub 2016 Jun 27.

Abstract

OBJECTIVES

Since the recent evidence of a tubal origin of most ovarian cancers, opportunistic salpingectomy could be discussed as a prophylactic strategy in the general population and with hereditary predisposition. We aimed to survey French gynecological surgeons about their current surgical practice of prophylactic salpingectomy.

METHODS

An anonymous online survey was sent to French obstetrician-gynaecologists and gynecological surgeons. There were 13 questions about their current clinical practice and techniques of salpingectomy during a benign hysterectomy or as a tubal sterilization method, salpingectomy versus salpingo-oophorectomy in the population with genetic risk, salpingectomy in relationship with endometriosis and questions including histopathological considerations.

RESULTS

Among the 569 respondents, opportunistic salpingectomy was always performed between 42.48% and 43.44% during laparoscopic, laparoscopic-assisted vaginal or laparotomic hysterectomy and only 12.26% in case of vaginal route. In the genetic population, salpingo-oophorectomy was mainly performed. Tubal sterilization was often practiced by the hysteroscopic route. More than 90% of respondents didn't perform salpingectomy in case of endometriosis. There was not any specific tubal histopathological protocol in 71.54% of cases.

CONCLUSIONS

Salpingectomy may be a preventing strategy in the low- and high-risk population. The survey's responses show that salpingectomy seems to be a current practice during benign hysterectomy for more than 40% doctors. However, there is not any change with no more salpingectomy in the population with genetic risk, or in case of endometriosis or tubal sterilization.

摘要

目的

鉴于近期多数卵巢癌起源于输卵管的证据,可将择期输卵管切除术作为一般人群及有遗传易感性人群的预防策略进行讨论。我们旨在调查法国妇科外科医生目前预防性输卵管切除术的手术实践情况。

方法

向法国妇产科医生和妇科外科医生发送了一份匿名在线调查问卷。问卷包含13个问题,涉及他们在良性子宫切除术中作为输卵管绝育方法时输卵管切除术的当前临床实践和技术、有遗传风险人群中输卵管切除术与输卵管卵巢切除术的对比、与子宫内膜异位症相关的输卵管切除术以及包括组织病理学考量在内的问题。

结果

在569名受访者中,在腹腔镜、腹腔镜辅助阴道或开腹子宫切除术中,总是进行择期输卵管切除术的比例在42.48%至43.44%之间,而经阴道途径时这一比例仅为12.26%。在有遗传风险的人群中,主要进行输卵管卵巢切除术。输卵管绝育术常通过宫腔镜途径实施。超过90%的受访者在子宫内膜异位症病例中不进行输卵管切除术。71.54%的病例没有任何特定的输卵管组织病理学方案。

结论

输卵管切除术可能是低风险和高风险人群的预防策略。调查结果显示,对于超过40%的医生而言,输卵管切除术似乎是良性子宫切除术期间的一种当前做法。然而,在有遗传风险的人群、子宫内膜异位症病例或输卵管绝育术中,没有更多进行输卵管切除术的变化。

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