Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet (Drs. Brunes, Söderberg, and Ek), Stockholm, Sweden; Division of Obstetrics and Gynecology, Södersjukhuset (Drs. Brunes, Söderberg, and Ek), Stockholm, Sweden.
Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet (Dr. Johannesson), Stockholm, Sweden; Division of Obstetrics and Gynecology, Danderyd Hospital (Dr. Johannesson), Stockholm, Sweden.
J Minim Invasive Gynecol. 2021 Feb;28(2):228-236. doi: 10.1016/j.jmig.2020.04.038. Epub 2020 May 6.
To assess if women with obesity have increased complication rates compared with women with normal weight undergoing hysterectomy for benign reasons and if the mode of hysterectomy affects the outcomes.
Cohort study.
Prospectively collected data from 3 Swedish population-based registers.
Women undergoing a total hysterectomy for benign indications in Sweden between January 1, 2015, and December 31, 2017. The patients were grouped according to the World Health Organization's classification of obesity.
Intraoperative and postoperative data were retrieved from the surgical register up to 1 year after the hysterectomy. Different modes of hysterectomy in patients with obesity were compared, such as open abdominal hysterectomy (AH), traditional laparoscopic hysterectomy (TLH), vaginal hysterectomy (VH), and robot-assisted laparoscopic hysterectomy (RTLH).
Out of 12,386 women who had a total hysterectomy during the study period, we identified 2787 women with normal weight and 1535 women with obesity (body mass index ≥30). One year after the hysterectomy, the frequency of complications was higher in women with obesity than in women with normal weight (adjusted odds ratio [aOR]) 1.4; 95% confidence interval [CI], 1.1-1.8). In women with obesity, AH was associated with a higher overall complication rate (aOR 1.8; 95% CI, 1.2-2.6) and VH had a slightly higher risk of intraoperative complications (aOR 4.4; 95% CI, 1.2-15.8), both in comparison with RTLH. Women with obesity had a higher rate of conversion to AH with conventional minimally invasive hysterectomy (TLH: aOR 28.2; 95% CI, 6.4-124.7 and VH: 17.1; 95% CI, 3.5-83.8, respectively) compared with RTLH. AH, TLH, and VH were associated with a higher risk of blood loss >500 mL than RTLH (aOR 11.8; 95% CI, 3.4-40.5; aOR 8.5; 95% CI, 2.5-29.5; and aOR 5.8; 95% CI, 1.5-22.8, respectively) in women with obesity.
The use of RTLH may lower the risk of conversion rates and intraoperative bleeding in women who are obese compared with other modes of hysterectomy.
评估肥胖女性在因良性原因接受子宫切除术的患者中与体重正常的患者相比，并发症发生率是否更高，以及子宫切除术的方式是否会影响结局。
队列研究。
从瑞典的 3 个基于人群的登记处前瞻性收集数据。
2015 年 1 月 1 日至 2017 年 12 月 31 日期间在瑞典因良性指征接受全子宫切除术的女性。患者根据世界卫生组织的肥胖分类进行分组。
在子宫切除术后 1 年内从手术登记处检索术中及术后数据。比较肥胖患者不同的子宫切除术方式，如开腹子宫切除术（AH）、传统腹腔镜子宫切除术（TLH）、经阴道子宫切除术（VH）和机器人辅助腹腔镜子宫切除术（RTLH）。
在研究期间接受全子宫切除术的 12386 名女性中，我们确定了 2787 名体重正常的女性和 1535 名肥胖女性（体重指数≥30）。子宫切除术后 1 年，肥胖女性的并发症发生率高于体重正常的女性（校正优势比[aOR]1.4；95%置信区间[CI]，1.1-1.8）。在肥胖女性中，AH 总体并发症发生率较高（aOR 1.8；95%CI，1.2-2.6），VH 术中并发症风险略高（aOR 4.4；95%CI，1.2-15.8），均与 RTLH 相比。与 RTLH 相比，肥胖女性经传统微创子宫切除术（TLH：aOR 28.2；95%CI，6.4-124.7 和 VH：aOR 17.1；95%CI，3.5-83.8）转为 AH 的比例更高。AH、TLH 和 VH 与 RTLH 相比，肥胖女性失血>500 mL 的风险更高（aOR 11.8；95%CI，3.4-40.5；aOR 8.5；95%CI，2.5-29.5；aOR 5.8；95%CI，1.5-22.8）。
与其他子宫切除术方式相比，RTLH 可降低肥胖女性中转率和术中出血的风险。
Zotero 插件