Department of Obstetrics and Gynecology, Case Western Reserve University School of Medicine (all authors); Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center (Drs. Chapman, Slopnick, Roberts, Wherley, and Mahajan); Department of Obstetrics and Gynecology, MetroHealth Medical Center (Drs. Chapman, Slopnick, Roberts, Sheyn, and Pollard), Cleveland, Ohio.
Department of Obstetrics and Gynecology, Case Western Reserve University School of Medicine (all authors); Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center (Drs. Chapman, Slopnick, Roberts, Wherley, and Mahajan); Department of Obstetrics and Gynecology, MetroHealth Medical Center (Drs. Chapman, Slopnick, Roberts, Sheyn, and Pollard), Cleveland, Ohio.
J Minim Invasive Gynecol. 2021 Feb;28(2):275-281. doi: 10.1016/j.jmig.2020.05.015. Epub 2020 May 22.
The objective of this study was to compare the morbidity of vaginal versus laparoscopic hysterectomy when performed with uterosacral ligament suspension.
Retrospective propensity-score matched cohort study.
American College of Surgeons National Surgical Quality Improvement Program database.
We included all patients who had undergone uterosacral ligament suspension and concurrent total vaginal hysterectomy (TVH-USLS) or total laparoscopic hysterectomy (TLH-USLS) from 2010 to 2015. We excluded those who underwent laparoscopic-assisted vaginal hysterectomy, abdominal hysterectomy, other surgical procedures for apical pelvic organ prolapse, or had gynecologic malignancy.
We compared 30-day complication rates in patients who underwent TVH-USLS versus TLH-USLS in both the total study population and a propensity score matched cohort.
The study population consisted of 3,349 patients who underwent TVH-USLS and 484 who underwent TLH-USLS. Patients who underwent TVH-USLS had a significantly higher composite complication rate (11.4% vs 6.4%, odds ratio [OR] 1.9, 1.3-2.8; p <.01) and a higher serious complication rate (5.6% vs 3.1%, OR 1.8, 1.1-3.1; p = .02), which excluded urinary tract infection and superficial surgical site infection. The propensity score analysis was performed, and patients were matched in a 1:1 ratio between the TVH-USLS group and the TLH-USLS group. In the matched cohort, patients who underwent TVH-USLS had a higher composite complication rate than those who underwent TLH-USLS (10.3% vs 6.4%, OR 1.7, 95% confidence interval [CI], 1.1-2.7; p = .04), whereas the rate of serious complications did not differ between the groups (4.3% vs 3.1%, OR 1.4, 95% CI, 0.7-2.8; p = .4). On multivariate logistic regression, TVH-USLS remained an independent predictor of composite complications (adjusted OR 1.6, 95% CI, 1.0-2.6; p = .04) but not serious complications (adjusted OR 1.4, 95% CI, 0.7-2.8; p = .3).
In this large national cohort, TVH-USLS was associated with a higher composite complication rate than TLH-USLS, largely secondary to an increased rate of urinary tract infection. After matching, the groups had similar rates of serious complications. These data suggest that TLH-USLS should be viewed as a safe alternative to TVH-USLS.
本研究旨在比较经阴道与腹腔镜子宫切除术联合子宫骶骨韧带悬吊术的发病率。
回顾性倾向评分匹配队列研究。
美国外科医师学会国家外科质量改进计划数据库。
我们纳入了 2010 年至 2015 年间接受子宫骶骨韧带悬吊术联合经阴道全子宫切除术（TVH-USLS）或全腹腔镜子宫切除术（TLH-USLS）的所有患者。我们排除了接受腹腔镜辅助阴道子宫切除术、腹式子宫切除术、其他用于治疗阴道顶端盆腔器官脱垂的手术或患有妇科恶性肿瘤的患者。
我们比较了 TVH-USLS 和 TLH-USLS 组在总研究人群和倾向评分匹配队列中的 30 天并发症发生率。
研究人群包括 3349 例接受 TVH-USLS 和 484 例接受 TLH-USLS 的患者。接受 TVH-USLS 的患者复合并发症发生率显著更高（11.4% vs. 6.4%，比值比 [OR] 1.9，1.3-2.8；p<0.01），严重并发症发生率更高（5.6% vs. 3.1%，OR 1.8，1.1-3.1；p=0.02），其中不包括尿路感染和浅表手术部位感染。进行了倾向评分分析，并在 TVH-USLS 组和 TLH-USLS 组之间以 1:1 的比例进行了患者匹配。在匹配队列中，接受 TVH-USLS 的患者复合并发症发生率高于接受 TLH-USLS 的患者（10.3% vs. 6.4%，OR 1.7，95%置信区间 [CI]，1.1-2.7；p=0.04），而两组严重并发症发生率无差异（4.3% vs. 3.1%，OR 1.4，95%CI，0.7-2.8；p=0.4）。多变量逻辑回归分析显示，TVH-USLS 仍然是复合并发症的独立预测因素（校正 OR 1.6，95%CI，1.0-2.6；p=0.04），但不是严重并发症的预测因素（校正 OR 1.4，95%CI，0.7-2.8；p=0.3）。
在这项大型全国队列研究中，TVH-USLS 与 TLH-USLS 相比，复合并发症发生率更高，主要与尿路感染发生率增加有关。匹配后，两组严重并发症发生率相似。这些数据表明，TLH-USLS 应被视为 TVH-USLS 的安全替代方案。
