次全子宫切除术后宫颈残端二次切除术的回顾性分析：为何及何时？
Retrospective analysis of secondary resection of the cervical stump after subtotal hysterectomy: why and when?
机构信息
Department of Obstetrics and Gynecology, University Hospital Tübingen, Calwerstrasse 7, 72076, Tübingen, Germany.
出版信息
Arch Gynecol Obstet. 2021 Dec;304(6):1519-1526. doi: 10.1007/s00404-021-06193-6. Epub 2021 Aug 28.
PURPOSE
The rates of hysterectomy are falling worldwide, and the surgical approach is undergoing a major change. To avoid abdominal hysterectomy, a minimally invasive approach has been implemented. Due to the increasing rates of subtotal hysterectomy, we are faced with the following questions: how often does the cervical stump have to be removed secondarily, and what are the indications?
METHODS
This was a retrospective, single-centre analysis of secondary resection of the cervical stump conducted from 2004 to 2018.
RESULTS
Secondary resection of the cervical stump was performed in 137 women. Seventy-four percent of the previous subtotal hysterectomy procedures were performed in our hospital, and 26% were performed in an external hospital. During the study period, 5209 subtotal hysterectomy procedures were performed at our hospital. The three main indications for secondary resection of the cervical stump were prolapse (31.4%), spotting (19.0%) and cervical dysplasia (18.2%). Unexpected histological findings (premalignant and malignant) after subtotal hysterectomy resulted in immediate (median time, 1 month) secondary resection of the cervical stump in 11 cases. In four patients, the indication was a secondary malignant gynaecological disease that occurred more than 5 years after subtotal hysterectomy. The median time between subtotal hysterectomy and secondary resection of the cervical stump was 40 months. Secondary resection of the cervical stump was performed vaginally in 75.2% of cases, laparoscopically in 20.4% of cases and abdominally in 4.4% of cases. The overall complication rate was 5%.
CONCLUSION
Secondary resection of the cervical stump is a rare surgery with a low complication rate and can be performed via the vaginal or laparoscopic approach in most cases. The most common indications are prolapse, spotting and cervical dysplasia. If a secondary resection of the cervical stump is necessary due to symptoms, 66.6% will be performed within the first 6 years after subtotal hysterectomy.
目的
全球范围内子宫切除术的比例正在下降，手术方法也正在发生重大变化。为了避免腹部子宫切除术，已经采用了微创方法。由于次全子宫切除术的比例不断增加，我们面临以下问题：宫颈残端需要多久进行二次切除，以及有哪些适应证？
方法
这是一项回顾性的、单中心的 2004 年至 2018 年期间宫颈残端二次切除的分析。
结果
对 137 名妇女进行了宫颈残端二次切除。74%的次全子宫切除术是在我院进行的，26%是在外部医院进行的。在研究期间，我院共进行了 5209 例次全子宫切除术。宫颈残端二次切除的三个主要适应证是脱垂（31.4%）、点滴出血（19.0%）和宫颈发育不良（18.2%）。次全子宫切除术后意外的组织学发现（癌前和恶性）导致 11 例立即（中位时间 1 个月）进行宫颈残端二次切除。在 4 例患者中，次全子宫切除术后 5 年以上发生了继发性妇科恶性疾病，是进行宫颈残端二次切除的指征。次全子宫切除术后至宫颈残端二次切除的中位时间为 40 个月。75.2%的病例经阴道进行宫颈残端二次切除，20.4%的病例经腹腔镜进行，4.4%的病例经腹部进行。总的并发症发生率为 5%。
结论
宫颈残端二次切除是一种罕见的手术，并发症发生率低，大多数情况下可经阴道或腹腔镜途径进行。最常见的适应证是脱垂、点滴出血和宫颈发育不良。如果由于症状需要进行宫颈残端二次切除，66.6%的患者将在次全子宫切除术后 6 年内进行。
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