Department of Obstetrics and Gynecology, Turku University Hospital, Turku, Finland.
Acta Obstet Gynecol Scand. 2019 Jan;98(1):44-50. doi: 10.1111/aogs.13459. Epub 2018 Oct 29.
Recently, it has been suggested that the occurrence of posthysterectomy vaginal cuff dehiscence has increased. Consequently, we evaluated the incidence of vaginal cuff dehiscence after different types of hysterectomies. Our hypothesis is that vaginal cuff dehiscence is more often associated with total laparoscopic hysterectomy (TLH) than other types of uterine removal.
A total of 13 645 hysterectomies from 1992 to 2015 were evaluated in the Turku University Hospital district, Finland. The primary outcome was occurrence of vaginal dehiscence after different types of hysterectomy. The hysterectomy and postoperative vaginal dehiscence trends were analyzed as the secondary outcome. In a subanalysis of dehiscence cases, women's characteristics and perioperative vaginal cuff opening and closure techniques were compared between conventional hysterectomies (vaginal, abdominal, and laparoscopic with vaginal closure) and TLH.
Altogether, 22 cases of vaginal cuff dehiscence were included. Most cases (n = 15) occurred after TLH (n = 1104), resulting in an incidence of 1.27%. After conventional laparoscopic hysterectomy with vaginal closure (n = 2853), vaginal (n = 4150), and abdominal (n = 5538) hysterectomies, the incidence rates were 0.11%, 0.05%, and 0.02%, respectively. Compared to abdominal hysterectomy, which was associated with the lowest incidence rate, vaginal dehiscence after TLH had an odds ratio (OR) 71.1 (9.34-541.38, P < 0.001). In the subanalysis of possible underlying factors, the technique of opening of the vaginal cuff with or without electrocoagulation, duration of operation, and occurrence of postoperative infection or hematoma prior to VCD were observed differences between TLH and conventional hysterectomies.
Compared with other types of hysterectomies, vaginal dehiscence was observed at the highest rate after TLH. Studies are needed to define if vaginal opening technique contributes to the risk of dehiscence.
最近有人提出，子宫切除术后阴道残端裂开的发生率有所增加。因此，我们评估了不同类型子宫切除术患者阴道残端裂开的发生率。我们的假设是，阴道残端裂开与全腹腔镜子宫切除术（TLH）的相关性高于其他类型的子宫切除术。
在芬兰图尔库大学医院区，评估了 1992 年至 2015 年期间的 13645 例子宫切除术。主要结局是不同类型子宫切除术后阴道残端裂开的发生率。次要结局是分析子宫切除术和术后阴道残端裂开的趋势。在裂开病例的亚分析中，比较了传统子宫切除术（阴道、腹部和腹腔镜联合阴道闭合）与 TLH 中女性特征以及围手术期阴道残端开口和闭合技术。
共纳入 22 例阴道残端裂开病例。大多数病例（n=15）发生在 TLH 后（n=1104），发生率为 1.27%。经阴道闭合的传统腹腔镜子宫切除术（n=2853）、阴道子宫切除术（n=4150）和腹部子宫切除术（n=5538）后，发生率分别为 0.11%、0.05%和 0.02%。与腹部子宫切除术相比，TLH 后阴道残端裂开的比值比（OR）为 71.1（9.34-541.38，P<0.001）。在潜在因素的亚分析中，观察到 TLH 和传统子宫切除术在阴道残端开口时是否使用电凝以及手术时间、术后感染或血肿发生与阴道残端裂开之间存在差异。
与其他类型的子宫切除术相比，TLH 后阴道残端裂开的发生率最高。需要进一步研究来确定阴道开口技术是否会增加裂开的风险。
