Department of Obstetrics and Gynecology, University of Nevada Las Vegas School of Medicine, Las Vegas, Nevada (Dr. Lua).
Department of Health Sciences Research, Section of Biostatistics, Mayo Clinic, Scottsdale, Arizona (Ms. Kosiorek).
J Minim Invasive Gynecol. 2019 Sep-Oct;26(6):1063-1069. doi: 10.1016/j.jmig.2018.10.010. Epub 2018 Oct 18.
To determine the feasibility of oophorectomy at the time of vaginal hysterectomy in patients with pelvic organ prolapse and to define prognostic factors and perioperative morbidity associated with the procedure.
A retrospective cohort study (Canadian Task Force classification II-2).
An academic medical center.
All women who underwent total vaginal hysterectomy for the treatment of pelvic organ prolapse over 5 years were considered for inclusion in the study.
Total vaginal hysterectomy and concomitant pelvic organ prolapse repair with or without oophorectomy.
A total of 289 women underwent total vaginal hysterectomy with pelvic organ prolapse repair. Vaginal oophorectomy was attempted in 179 patients (61.9%). The procedure was successful in 150 patients (83.8%; 95% confidence interval [CI], 77.6%-88.9%). High ovarian location was the most commonly cited reason for the inability to perform a planned unilateral/bilateral oophorectomy (n = 24, 82.7%). Attempting oophorectomy vaginally was associated with an increased duration of surgery by 7.3 minutes (p = .03), an increased change in hemoglobin by 0.2 g/dL (p = .02), and a higher rate of readmission (7.3% vs 1.8%, p = .04). Multiple logistic regression showed that increasing age (odds ratio = 1.12; 95% CI, 1.05-1.20; p <.001) and body mass index (odds ratio = 1.17; 95% CI, 1.07-1.27; p<.001) were associated with an increased risk of vaginal oophorectomy failure. On univariate analysis, race (p = .64), parity (p = .39), uterine weight (p = .91), need for uterine morcellation (p=.21), presence of endometriosis (p=.66), prior cesarean section (p=.63), prior laparoscopy (p=.37), and prior open abdominal/pelvic surgery (p = .28) did not impact the likelihood of successfully performing oophorectomy.
In patients with pelvic organ prolapse, a planned oophorectomy at the time of vaginal hysterectomy can be successfully performed in the majority of cases. Greater age and body mass index are associated with an increased likelihood of failure.
确定在阴道子宫切除术时同时行卵巢切除术治疗盆腔器官脱垂的可行性，并确定与该手术相关的预后因素和围手术期发病率。
回顾性队列研究（加拿大任务组分类 II-2）。
一所学术医疗中心。
所有在 5 年内因盆腔器官脱垂接受经阴道子宫切除术的女性均被认为适合纳入研究。
经阴道子宫切除术和盆腔器官脱垂修复术，伴或不伴卵巢切除术。
共有 289 名女性接受了经阴道子宫切除术和盆腔器官脱垂修复术。179 名患者（61.9%）尝试行阴道卵巢切除术。在 150 名患者（83.8%；95%置信区间 [CI]，77.6%-88.9%）中，该手术成功。卵巢高位是导致无法行计划单侧/双侧卵巢切除术的最常见原因（n=24，82.7%）。经阴道行卵巢切除术与手术时间延长 7.3 分钟（p=0.03）、血红蛋白变化增加 0.2 g/dL（p=0.02）和再入院率增加（7.3%比 1.8%，p=0.04）相关。多因素逻辑回归显示，年龄增加（比值比=1.12；95%CI，1.05-1.20；p<0.001）和体重指数增加（比值比=1.17；95%CI，1.07-1.27；p<.001）与阴道卵巢切除术失败的风险增加相关。单因素分析显示，种族（p=0.64）、产次（p=0.39）、子宫重量（p=0.91）、需要子宫分碎术（p=0.21）、子宫内膜异位症（p=0.66）、剖宫产史（p=0.63）、腹腔镜检查史（p=0.37）和开腹/盆腔手术史（p=0.28）均不影响卵巢切除术成功的可能性。
在患有盆腔器官脱垂的患者中，阴道子宫切除术时行计划性卵巢切除术可在大多数情况下成功进行。年龄较大和体重指数较高与失败的可能性增加相关。
