Departments of Gynecology and Obstetrics, Aalborg University Hospital, Aalborg, Denmark; Departments of Surgical Gastroenterology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark.
Departments of Surgical Gastroenterology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark.
J Minim Invasive Gynecol. 2018 May-Jun;25(4):715-723.e2. doi: 10.1016/j.jmig.2017.11.017. Epub 2017 Dec 1.
To estimate the risk of venous thromboembolic complications after abdominal, laparoscopic, and vaginal hysterectomy when performed for benign disorders.
A nationwide cohort study (Canadian Task Force classification II-2).
Data from Danish national registers on all women undergoing hysterectomy for benign conditions from 1996 to 2015.
Women aged 18 years and older who underwent hysterectomy for benign disease were stratified into 3 groups according to the hysterectomy approach: abdominal, laparoscopic, or vaginal.
Hysterectomy.
Eighty-nine thousand nine hundred thirty-one women met the inclusion criteria. Venous thromboembolism (VTE) as a diagnosis or cause of death was identified. The risk of postoperative VTE was examined with Cox proportional hazard models adjusting for age, surgical approach, and relevant comorbidities. The mean age was 49.9, 47.9, and 54.3 years for women with abdominal, laparoscopic, and vaginal hysterectomy, respectively. The crude incidences of VTE within 30 days after hysterectomy were 0.24% (n = 142), 0.13% (n = 12), and 0.10% (n = 21). The most important predictors of VTE were the approach to hysterectomy and a history of thromboembolic disease. In the multivariable analysis, the risk of VTE was significantly reduced with laparoscopic hysterectomy (hazard ratio [HR] = 0.51; 95% confidence interval [CI], 0.28-0.92; p = .03) and vaginal hysterectomy (HR = 0.39; 95% CI, 0.24-0.63; p < .001) when compared with the abdominal procedure. Data on postoperative heparin thromboprophylaxis were available in 53 566 patients, and the adjusted HR was 0.63 (95% CI, 0.42-0.96; p = .03) in patients receiving heparin thromboprophylaxis.
The 30-day cumulative incidence of VTE after hysterectomy for benign conditions was low overall (0.19%). Laparoscopic hysterectomy and vaginal hysterectomy carry a lower risk than the abdominal procedure. Postoperative heparin thromboprophylaxis significantly reduces the risk of VTE and should be considered, especially if risk factors are present.
评估因良性疾病行腹式、腹腔镜和阴式子宫切除术的静脉血栓栓塞并发症风险。
全国性队列研究（加拿大工作小组分类 II-2 级）。
1996 年至 2015 年丹麦全国子宫切除术良性疾病患者登记数据。
年龄 18 岁及以上因良性疾病行子宫切除术的患者，根据手术方式分为腹式、腹腔镜和阴式 3 组。
子宫切除术。
8931 名女性符合纳入标准。通过 Cox 比例风险模型识别术后静脉血栓栓塞（VTE）的诊断或死因。调整年龄、手术方式和相关合并症后，评估术后 VTE 风险。患者平均年龄分别为 49.9、47.9 和 54.3 岁。术后 30 天内 VTE 的粗发生率分别为 0.24%（142 例）、0.13%（12 例）和 0.10%（21 例）。VTE 的最重要预测因素是手术方式和血栓栓塞病史。多变量分析显示，腹腔镜子宫切除术（风险比 [HR] = 0.51；95%置信区间 [CI]，0.28-0.92；p = .03）和阴式子宫切除术（HR = 0.39；95% CI，0.24-0.63；p < .001）显著降低了 VTE 风险。53566 名患者有术后肝素预防血栓形成的数据，接受肝素预防血栓形成的调整 HR 为 0.63（95% CI，0.42-0.96；p = .03）。
良性疾病子宫切除术后 30 天内 VTE 的累积发生率总体较低（0.19%）。腹腔镜子宫切除术和阴式子宫切除术的风险低于腹式手术。术后肝素预防血栓形成可显著降低 VTE 风险，尤其在存在危险因素时应考虑使用。
