Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Sweden; Division of Obstetrics and Gynecology at Södersjukhuset, Stockholm, Sweden.
Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Sweden; Division of Obstetrics and Gynecology at Danderyd Hospital, Stockholm, Sweden.
Eur J Obstet Gynecol Reprod Biol. 2022 May;272:104-109. doi: 10.1016/j.ejogrb.2022.02.180. Epub 2022 Mar 9.
To assess whether hysterectomy in patients with endometriosis is associated with higher proportion of complications compared with patients without, and whether route of hysterectomy affects this outcome.
This is a population-based retrospective cohort study. Data were prospectively obtained from three National Swedish Registers. Patients undergoing a benign hysterectomy between 2015 and 2017 in Sweden were included in the study and were grouped according to a histology-proven diagnosis of endometriosis. Different hysterectomy modes were compared in patients with endometriosis. Perioperative data and postoperative complications up to 1 year after surgery were collected and measured.
In all, 8,747 patients underwent a benign hysterectomy, and 1,166 patients with endometriosis was compared with 7,581 patients without. Patients with endometriosis had higher proportion of complications (adjusted Odds ratio aOR 1.2, 95% CI 1.0-1.4), were more often converted to abdominal hysterectomy (aOR 1.7, 95% CI 1.1-2.6), had higher estimated blood loss (EBL) (200-500 ml; aOR 1.8, 95% CI 1.4-2.3, >500 ml; aOR 3.1, 95% CI 2.2-4.4) and a longer operative time (1-2 h; aOR 2.1, 95% CI 1.4-3.2, >2 h; aOR 4.3, 95% CI 2.7-6.6) than endometriosis-free patients. The conversion rate was 13.8 times higher in total laparoscopic hysterectomy (TLH) compared with robotic-assisted laparoscopic hysterectomy (RATLH) (aOR 13.8, 95% CI 3.6-52.4).
Higher conversion rate, higher EBL and higher frequency of complications were seen in patients with endometriosis. RATLH was associated with lower conversion rate compared to TLH.
评估子宫内膜异位症患者的子宫切除术与无子宫内膜异位症患者相比，其并发症的比例是否更高，以及子宫切除术的途径是否会影响这一结果。
这是一项基于人群的回顾性队列研究。数据从三个瑞典国家注册中心前瞻性获得。纳入了 2015 年至 2017 年期间在瑞典接受良性子宫切除术的患者，并根据组织学证实的子宫内膜异位症诊断对其进行分组。比较了子宫内膜异位症患者的不同子宫切除术方式。收集并测量了手术期间和术后 1 年内的围手术期数据和术后并发症。
共有 8747 名患者接受了良性子宫切除术，其中 1166 名子宫内膜异位症患者与 7581 名无子宫内膜异位症患者进行了比较。患有子宫内膜异位症的患者并发症的比例更高（校正比值比 aOR 1.2，95%CI 1.0-1.4），更常转为腹式子宫切除术（aOR 1.7，95%CI 1.1-2.6），估计出血量更多（200-500ml；aOR 1.8，95%CI 1.4-2.3，>500ml；aOR 3.1，95%CI 2.2-4.4），手术时间更长（1-2 小时；aOR 2.1，95%CI 1.4-3.2，>2 小时；aOR 4.3，95%CI 2.7-6.6）。与无子宫内膜异位症的患者相比，经阴道子宫切除术（TLH）的转换率高 13.8 倍（aOR 13.8，95%CI 3.6-52.4）。
患有子宫内膜异位症的患者的转换率更高、估计出血量更多、并发症发生率更高。与 TLH 相比，RATLH 与较低的转换率相关。
