Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, University of British Columbia, Vancouver, British Columbia, Canada.
Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, University of British Columbia, Vancouver, British Columbia, Canada.
Am J Obstet Gynecol. 2017 Mar;216(3):270.e1-270.e9. doi: 10.1016/j.ajog.2016.10.035. Epub 2016 Nov 1.
Ovarian cancer is the leading cause of death due to gynecologic malignancy and the fifth most common cause of cancer deaths in developed countries. Recent evidence has indicated that the most common and lethal form of ovarian cancer originates in the distal fallopian tube, and recommendations for surgical removal of the fallopian tube (bilateral salpingectomy) at the time of other gynecologic surgeries (particularly hysterectomy and tubal sterilization) have been made, most recently by the American Congress of Obstetricians and Gynecologists.
We sought to assess the uptake and perioperative safety of bilateral salpingectomy at the time of hysterectomy and tubal sterilization in the United States and to examine the factors associated with increased likelihood of bilateral salpingectomy.
The Nationwide Inpatient Sample was used to identify all girls and women 15 years or older without gynecologic cancer who underwent inpatient hysterectomy or tubal sterilization, with and without bilateral salpingectomy, from 2008 through 2013. Weighted estimates of national rates of these procedures were calculated and the number of procedures performed estimated. Safety was assessed by examining rates of blood transfusions, perioperative complications, postprocedural infection, and fever, and adjusted odds ratios were calculated comparing hysterectomy with salpingectomy with hysterectomy alone.
We included 425,180 girls and women who underwent inpatient hysterectomy from 2008 through 2013 representing a national cohort of 2,036,449 (95% confidence interval, 1,959,374-2,113,525) girls and women. There was an increase in the uptake of hysterectomy with bilateral salpingectomy of 371% across the study period, with 7.7% of all hysterectomies including bilateral salpingectomy in 2013 (15.8% among girls and women retaining their ovaries). There were only 1195 salpingectomies for sterilization, thus no further comparisons were possible. In the girls and women who had hysterectomy with bilateral salpingectomy, there was no increased risk for blood transfusion (adjusted odds ratio, 0.95; 95% confidence interval, 0.86-1.05) postoperative complications (adjusted odds ratio, 0.97; 95% confidence interval, 0.88-1.07), postoperative infections (adjusted odds ratio, 1.26; 95% confidence interval, 0.90-1.78), or fevers (adjusted odds ratio, 1.33; 95% confidence interval, 1.00-1.77) compared with women undergoing hysterectomy alone. Younger age, private for-profit hospital setting, larger hospital size, and indication for hysterectomy were all associated with increased likelihood of getting a hysterectomy with bilateral salpingectomy in women retaining their ovaries.
Our results suggest that hysterectomy with bilateral salpingectomy is significantly increasing in the United States and is not associated with increased risks of postoperative complications.
卵巢癌是妇科恶性肿瘤导致死亡的主要原因，也是发达国家癌症死亡的第五大常见原因。最近的证据表明，最常见和最致命的卵巢癌形式起源于输卵管的远端，并且建议在其他妇科手术（特别是子宫切除术和输卵管绝育术）时同时切除输卵管（双侧输卵管切除术），最近美国妇产科医师大会也提出了这一建议。
我们旨在评估在美国子宫切除术和输卵管绝育术中双侧输卵管切除术的采用率和围手术期安全性，并研究与双侧输卵管切除术可能性增加相关的因素。
利用全国住院患者样本，确定了 2008 年至 2013 年间所有年龄在 15 岁及以上、无妇科癌症、接受住院子宫切除术或输卵管绝育术（包括或不包括双侧输卵管切除术）的女性。计算了这些手术的全国发生率的加权估计值，并估计了手术数量。通过检查输血、围手术期并发症、术后感染和发热的发生率来评估安全性，并通过比较同时行子宫切除术和输卵管切除术与单纯行子宫切除术的输血率、围手术期并发症率、术后感染率和发热率来计算调整后的优势比。
我们纳入了 2008 年至 2013 年间接受住院子宫切除术的 425180 名女性，代表了 2036449 名（95%置信区间，1959374-2113525）女性的全国队列。研究期间，同时行子宫切除术和双侧输卵管切除术的比例增加了 371%，2013 年所有子宫切除术中有 7.7%包括双侧输卵管切除术（保留卵巢的女性中占 15.8%）。仅有 1195 例输卵管绝育术，因此无法进行进一步比较。在同时行子宫切除术和双侧输卵管切除术的女性中，输血风险没有增加（调整后的优势比，0.95；95%置信区间，0.86-1.05），术后并发症风险（调整后的优势比，0.97；95%置信区间，0.88-1.07）、术后感染风险（调整后的优势比，1.26；95%置信区间，0.90-1.78）或发热风险（调整后的优势比，1.33；95%置信区间，1.00-1.77）与单纯行子宫切除术的女性相比。年轻、私立营利性医院环境、更大的医院规模和子宫切除术的指征均与保留卵巢的女性双侧输卵管切除术的可能性增加相关。
我们的研究结果表明，同时行子宫切除术和双侧输卵管切除术在美国显著增加，并且与术后并发症风险增加无关。
