良性子宫切除术的并发症：基于人群的丹麦子宫切除术数据库前瞻性队列研究，2004-2015 年。
Complications after benign hysterectomy, according to procedure: a population-based prospective cohort study from the Danish hysterectomy database, 2004-2015.
机构信息
Department of Gynaecology and Obstetrics, North Zealand University Hospital, Hilleroed, Denmark.
Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark.
出版信息
BJOG. 2020 Sep;127(10):1269-1279. doi: 10.1111/1471-0528.16200. Epub 2020 Apr 1.
OBJECTIVE
To compare the risk of complications associated with benign hysterectomy according to surgical procedure.
DESIGN
Register-based prospective cohort study.
SETTING
Danish Hysterectomy Database, 2004-2015.
POPULATION
All Danish women with benign elective hysterectomy (n = 51 141).
METHODS
Multivariate log-binomial regression to compute relative risks (RRs) stratified by calendar period, and adjusted for age, height, weight, smoking habits, use of alcohol, comorbidity, indications, uterine weight and adhesions. Multiple imputation and 'intention to treat' analyses were performed.
MAIN OUTCOME MEASURES
Major (grades III-V) and minor (grades I-II) Clavien-Dindo modified complications within 30 days.
RESULTS
Overall, major complications occurred in 3577 (7.0%) hysterectomies and minor complications occurred in 4788 (9.4%). The proportions of major and minor complications according to type of hysterectomy were: 10.3 and 9.6% for abdominal hysterectomy (AH); 4.1 and 12.1% for laparoscopic hysterectomy (LH); and 4.9 and 8.0% for vaginal hysterectomy (VH) for non-prolapse, and 2.3 and 6.4% for prolapse. In multivariate analyses, compared with VH for non-prolapse, the risk of major complications was higher for AH (RR 1.82, 95% CI 1.63-2.03) but lower for both LH (RR 0.78, 95% CI 0.68-0.90) and VH for prolapse (RR 0.55; 95% CI 0.41-0.75). For LH, the risk of major complications reduced from a RR of 0.96 (95% CI 0.75-1.22) in the time period 2004-2009 to an RR of 0.72 (95% CI 0.60-0.87) between 2010 and 2015.
CONCLUSION
Laparoscopic hysterectomy and VH for uterine prolapse are associated with fewer major complications, and AH is associated with more major complications, compared with VH performed in the absence of uterine prolapse.
TWEETABLE ABSTRACT
Laparoscopic hysterectomy has fewer major complications compared with vaginal hysterectomy, in the absence of uterine prolapse.
目的
比较良性子宫切除术相关并发症的风险，按手术方式分层。
设计
基于注册的前瞻性队列研究。
地点
丹麦子宫切除术数据库，2004-2015 年。
人群
所有接受良性择期子宫切除术的丹麦妇女（n=51141）。
方法
采用多变量对数二项式回归计算风险比（RR），按时间分层，并调整年龄、身高、体重、吸烟习惯、饮酒、合并症、适应证、子宫重量和粘连。进行多重插补和“意向治疗”分析。
主要结局指标
30 天内主要（III-V 级）和次要（I-II 级）Clavien-Dindo 改良并发症。
结果
总体而言，3577 例（7.0%）子宫切除术出现主要并发症，4788 例（9.4%）出现次要并发症。根据子宫切除术类型，主要和次要并发症的比例为：非脱垂时，开腹子宫切除术（AH）为 10.3%和 9.6%，腹腔镜子宫切除术（LH）为 4.1%和 12.1%，阴道子宫切除术（VH）为 4.9%和 8.0%；脱垂时为 2.3%和 6.4%。多变量分析显示，与非脱垂时的 VH 相比，AH 的主要并发症风险更高（RR 1.82，95%CI 1.63-2.03），而 LH（RR 0.78，95%CI 0.68-0.90）和脱垂时的 VH（RR 0.55；95%CI 0.41-0.75）的风险较低。LH 的主要并发症风险从 2004-2009 年的 RR 0.96（95%CI 0.75-1.22）降低到 2010-2015 年的 RR 0.72（95%CI 0.60-0.87）。
结论
与非脱垂时的 VH 相比，LH 和脱垂时的 VH 与较少的主要并发症相关，而 AH 与更多的主要并发症相关。
推文摘要
与非脱垂时的 VH 相比，腹腔镜子宫切除术与较少的主要并发症相关，而在没有子宫脱垂的情况下，开腹子宫切除术与更多的主要并发症相关。
Zotero 插件