Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Department of Obstetrics and Gynecology, Shenzhen Hospital of Southern Medical University, Shenzhen, China.
Gynecol Oncol. 2020 Aug;158(2):294-302. doi: 10.1016/j.ygyno.2020.05.029. Epub 2020 Jun 2.
The primary objective was to describe the incidence and risk factors of urologic complications during radical hysterectomy for cervical cancer. The secondary objective was to investigate the impact of urologic complications on long-term survival.
Patients who underwent radical hysterectomy for cervical cancer from 2004 to 2016 were identified in the MSCCCC (Major Surgical Complications of Cervical Cancer in China) database. Data on demographic characteristics, clinical characteristics, hospital characteristics and urologic complications were collected. Multivariable logistic regression was used to assess the risk factors of urologic complications and Cox proportional hazards models were performed to identify prognostic factors.
A total of 21,026 patients undergoing radical hysterectomy for cervical cancer were identified. The incidence of any urologic complications was 1.54%: 83 (0.39%) ureteral injuries, 17 (0.08%) bladder injuries, 1 (0.005%) ureteral injury combined with bladder injury, and 223 (1.05%) genitourinary fistulas. In a multivariable analysis, surgery at a women and children's hospital (OR = 2.26, 95% CI 1.47-3.48), surgery at a facility in a first-tier city (OR = 2.08, 95% CI 1.24-3.48), and laparoscopic surgery (OR = 4.68, 95% CI 3.44-6.36) were associated with a higher risk of urologic complications. Cox proportional hazards models revealed that the occurrence of urologic complications was a significant predictor of 2-year overall survival (OR = 1.78, 95% CI = 1.09-2.92), but was not a predictor of 5-year overall survival (OR = 1.27, 95% CI = 0.83-1.94).
The incidence of urologic complications during radical hysterectomy is low. The risk of urologic complications may be higher for patients who are treated at a women and children's hospital, are treated in first-tier city hospitals, and receive laparoscopic surgery. Urologic complications have an impact on short-term survival, but not on long-term survival.
主要目的是描述宫颈癌根治性子宫切除术中泌尿系统并发症的发生率和危险因素。次要目的是探讨泌尿系统并发症对长期生存的影响。
在中国宫颈癌重大手术并发症（MSCCCC）数据库中，确定了 2004 年至 2016 年期间接受根治性子宫切除术治疗宫颈癌的患者。收集了人口统计学特征、临床特征、医院特征和泌尿系统并发症的数据。采用多变量逻辑回归评估泌尿系统并发症的危险因素，并采用 Cox 比例风险模型确定预后因素。
共确定了 21026 例接受宫颈癌根治性子宫切除术的患者。任何泌尿系统并发症的发生率为 1.54%：83 例（0.39%）输尿管损伤，17 例（0.08%）膀胱损伤，1 例（0.005%）输尿管损伤合并膀胱损伤，223 例（1.05%）泌尿生殖瘘。多变量分析显示，在妇女儿童医院进行手术（OR=2.26，95%CI 1.47-3.48）、在一线城市医院进行手术（OR=2.08，95%CI 1.24-3.48）和腹腔镜手术（OR=4.68，95%CI 3.44-6.36）与泌尿系统并发症的风险增加相关。Cox 比例风险模型显示，泌尿系统并发症的发生是 2 年总生存率的显著预测因素（OR=1.78，95%CI=1.09-2.92），但不是 5 年总生存率的预测因素（OR=1.27，95%CI=0.83-1.94）。
根治性子宫切除术中泌尿系统并发症的发生率较低。在妇女儿童医院接受治疗、在一线城市医院接受治疗和接受腹腔镜手术的患者发生泌尿系统并发症的风险可能更高。泌尿系统并发症对短期生存有影响，但对长期生存没有影响。
