Hassani Daisy B, Mangel Jeffrey M, Mahajan Sangeeta T, Hijaz Adonis K, El-Nashar Sherif, Sheyn David
Department of Obstetrics and Gynecology, University Hospitals Case Medical Center, Cleveland, OH, USA.
Division of Female Pelvic Medicine and Reconstructive Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Int Urogynecol J. 2019 Mar;30(3):447-453. doi: 10.1007/s00192-018-3652-0. Epub 2018 Apr 14.
Opportunistic salpingectomy (OS) at the time of benign hysterectomy has recently emerged as a potential primary preventive modality for ovarian cancer. Our objective was to determine whether the reported rate of OS at the time of prolapse surgery is similar to the rate of OS at the time of gynecologic surgery for non-prolapse indications.
An anonymous online survey was sent to the Society of Gynecologic Surgery members. Responses were divided into surgeons who did and did not perform OS at the time of prolapse repair. Differences between surgeons who did and did not perform OS were evaluated using the chi-square test. Multivariable logistic regression was used to identify which responses related to increased odds of performing OS.
There were 117 (33.1%) completed responses; of these, 98 (83.8%) reported performing OS at the time of prolapse repair, which was similar to the reported rate of OS at the time of hysterectomy for non-prolapse indications, 82.1%. After multivariable logistic regression, performance of salpingectomy at the time of hysterectomy for a non-prolapse indication (aOR: 17.9, 95% CI: 3.11-42.01), use of a laparoscopic or robotic surgical approach (aOR 14.1, 95% CI: 1.81-32.21) and completion of an FPMRS fellowship (aOR: 3.47, 95% CI: 1.20-10.02) were associated with a higher likelihood of performing OS at the time of prolapse repair.
OS at the time prolapse repair is performed more frequently with concomitant hysterectomy compared with OS at the time of post-hysterectomy prolapse repair and is similar to rates of OS performed at the time of hysterectomy for non-prolapse indications.
在良性子宫切除术时进行的机会性输卵管切除术（OS）最近已成为卵巢癌潜在的一级预防方式。我们的目的是确定脱垂手术时报告的OS发生率是否与非脱垂指征的妇科手术时的OS发生率相似。
向妇科外科学会成员发送了一份匿名在线调查问卷。回复被分为在脱垂修复时进行和未进行OS的外科医生。使用卡方检验评估进行和未进行OS的外科医生之间的差异。多变量逻辑回归用于确定哪些回复与进行OS的几率增加有关。
共收到117份（33.1%）完整回复；其中，98份（83.8%）报告在脱垂修复时进行了OS，这与非脱垂指征子宫切除术时报告的OS发生率82.1%相似。经过多变量逻辑回归分析，非脱垂指征子宫切除术时进行输卵管切除术（调整后比值比：17.9，95%置信区间：3.11 - 42.01）、使用腹腔镜或机器人手术方法（调整后比值比14.1，95%置信区间：1.81 - 32.21）以及完成女性盆底医学与重建外科学 fellowship（调整后比值比：3.47，95%置信区间：1.20 - 10.02）与脱垂修复时进行OS的可能性较高相关。
与子宫切除术后脱垂修复时的OS相比，脱垂修复时同时进行子宫切除术的OS更为常见，且与非脱垂指征子宫切除术时的OS发生率相似。
