Department of Obstetrics and Gynecology, Nykoebing Falster Hospital, Nykoebing Falster, Denmark; University of Southern Denmark, Odense, Denmark.
Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark.
Eur J Obstet Gynecol Reprod Biol. 2019 Sep;240:144-150. doi: 10.1016/j.ejogrb.2019.06.025. Epub 2019 Jun 22.
The effect of prophylactic vaginal vault suspension during hysterectomy in prevention of subsequent development of pelvic organ prolapse (POP) is unknown. We aimed to investigate incidences and risk of POP surgery in women who had undergone hysterectomy on benign indication with and without prophylactic suspension.
We linked the national clinical Danish Hysterectomy and Hysteroscopy Database (DHHD) to administrative registries to assess data on all total hysterectomies (1 May 2012 to 31 December 2014), suspension methods, age, POP surgery, births, obstetric complications, prescriptions, socioeconomic- and vital status. Women undergoing total hysterectomy on non-prolapse and benign indication with no prior POP surgery were included and followed from hysterectomy to POP surgery, death/emigration or end of study period (maximum 2 years). Descriptive statistics, cumulative incidence curves and multivariable Cox proportional hazard models were fitted to assess the associated risk of POP in relation to prophylactic suspension.
We included 7625 patients undergoing total hysterectomy; of these, 6538 (85.7%) were registered with prophylactic suspension during hysterectomy and 1087 (14.3%) women were specifically registered with no suspension in the DHHD. At baseline, women undergoing hysterectomy with suspension were on average 47.1 years of age (standard error SE 0.1) compared to 48.4 years (SE 0.3) in women with no suspension (p-value <0.0001). Moreover, women with suspension differed from their counterparts with no suspension with respect to geographical site of hysterectomy, hysterectomy method, parity and income. The cumulative risk of POP surgery after two years follow-up was 0.9% and 0.5% in the suspension group and the no suspension group, respectively. In the adjusted analysis, we found no association of prophylactic suspension and risk of POP surgery, hazard ratio (HR) = 2.1 (95% confidence interval (CI) 0.8-5.3, p-value 0.13).
Of all women undergoing hysterectomy for benign indication, 0.84% (N = 64) were surgically treated for POP. At two-year follow-up, there was no association between prophylactic vaginal vault suspension at time of hysterectomy and subsequent POP surgery.
预防性阴道穹窿悬吊术在预防子宫切除术后盆腔器官脱垂（POP）发展方面的效果尚不清楚。本研究旨在探讨在因良性疾病行子宫切除术的患者中，预防性悬吊术与未行预防性悬吊术患者 POP 手术的发生率和风险。
我们将全国临床丹麦子宫切除术和宫腔镜数据库（DHHD）与行政登记处进行了链接，以评估所有全子宫切除术（2012 年 5 月 1 日至 2014 年 12 月 31 日）、悬吊方法、年龄、POP 手术、分娩、产科并发症、处方、社会经济和生命状况的数据。纳入因非脱垂和良性疾病行全子宫切除术且术前无 POP 手术史的患者，自子宫切除术起随访至 POP 手术、死亡/移民或研究结束（最长 2 年）。采用描述性统计、累积发生率曲线和多变量 Cox 比例风险模型来评估预防性悬吊术与 POP 相关的风险。
共纳入 7625 例行全子宫切除术的患者；其中，6538 例（85.7%）在子宫切除术中行预防性悬吊术，1087 例（14.3%）患者在 DHHD 中明确登记未行悬吊术。基线时，行悬吊术的子宫切除术患者平均年龄为 47.1 岁（标准误差 SE 0.1），而未行悬吊术的患者为 48.4 岁（SE 0.3）（p<0.0001）。此外，行悬吊术的患者与未行悬吊术的患者在子宫切除术的地理位置、手术方法、产次和收入方面存在差异。两年随访后，悬吊组和未悬吊组 POP 手术的累积风险分别为 0.9%和 0.5%。在调整分析中，我们发现预防性悬吊术与 POP 手术风险之间无关联，风险比（HR）为 2.1（95%置信区间（CI）0.8-5.3，p 值 0.13）。
在因良性疾病行子宫切除术的所有患者中，有 0.84%（N=64）因 POP 而行手术治疗。在两年随访时，子宫切除术中预防性阴道穹窿悬吊术与随后的 POP 手术之间无关联。
