Schmitt Jennifer J, Occhino John A, Weaver Amy L, McGree Michaela E, Gebhart John B
Division of Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota.
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
J Minim Invasive Gynecol. 2017 Nov-Dec;24(7):1158-1169. doi: 10.1016/j.jmig.2017.06.026. Epub 2017 Jul 6.
To compare outcomes of vaginal hysterectomy (VH) and robotic-assisted hysterectomy (RH) among women with conditions perceived as contraindications to VH (uterine size ≥ 12 weeks' gestation, no vaginal parity, prior cesarean delivery, and obesity).
Retrospective chart review (Canadian Task Force classification II-2).
Tertiary US medical center.
Women with VH or RH. Women with conditions perceived as contraindications affecting surgical choice were excluded.
VH or RH for benign uterine disease at our institution during 2009 through 2013.
Among women with the perceived contraindications, a logistic regression model was fit to compare each binary outcome between VH and RH. Models were weighted using inverse probability of treatment weights derived from propensity scores to adjust for covariate imbalance between procedures. The cohort had 692 VHs and 472 RHs. Among 160 women with uterine size ≥ 12 weeks' gestation, RH patients were less likely to have uterine debulking (adjusted odds ratio [aOR], .37; 95% confidence interval [CI], .15-.95]) than VH patients and more likely to have accordion grade ≥ 2 postoperative complications (aOR, 7.20; 95% CI, 1.46-35.42) and readmission (aOR, 15.55; 95% CI. .85-285.20). Among 272 women with prior cesarean section, RH patients were more likely to have grade ≥ 2 postoperative complications (aOR, 2.85; 95% CI, 1.29-6.30). No outcomes were significantly different between surgical routes among women with no vaginal parity or obesity. Mean operative time was significantly longer for RH.
VH is a surgical option for patients with the conditions perceived as contraindications for vaginal surgery evaluated herein.
比较在被视为阴道子宫切除术（VH）禁忌证（子宫大小≥孕12周、未顺产、既往剖宫产史和肥胖）的女性中，阴道子宫切除术（VH）与机器人辅助子宫切除术（RH）的手术结局。
回顾性病历审查（加拿大工作组分类II-2）。
美国三级医疗中心。
接受VH或RH手术的女性。排除有被视为影响手术选择的禁忌证的女性。
2009年至2013年期间在本机构对良性子宫疾病行VH或RH手术。
在有上述禁忌证的女性中，采用逻辑回归模型比较VH和RH之间的各项二元结局。使用从倾向得分得出的治疗权重的逆概率对模型进行加权，以调整手术之间的协变量不平衡。该队列中有692例行VH手术者和472例行RH手术者。在160名子宫大小≥孕12周的女性中，RH手术患者进行子宫减瘤的可能性低于VH手术患者（校正优势比[aOR]，0.37；95%置信区间[CI]，0.15 - 0.95），且发生手风琴分级≥2级术后并发症（aOR，7.20；95% CI，1.46 - 35.42）和再次入院（aOR，15.55；95% CI，0.85 - 285.20）的可能性高于VH手术患者。在272名有剖宫产史的女性中，RH手术患者发生≥2级术后并发症的可能性更高（aOR，2.85；95% CI，1.29 - 6.30）。在未顺产或肥胖的女性中，两种手术方式的结局无显著差异。RH手术的平均手术时间明显更长。
对于本文评估的被视为阴道手术禁忌证的患者，VH是一种手术选择。
