Tebeu P M, Tayou R, Antaon J S S, Mawamba Y N, Koh V M, Ngou-Mve-Ngou J P
Central African Centre for Higher Education in Public Health (CIESPAC), Brazzaville, Congo, Cameroon.
Department of Gynaecology & Obstetrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
J West Afr Coll Surg. 2019 Jul-Sep;9(3):1-7. doi: 10.4103/jwas.jwas_900_19. Epub 2022 Jan 5.
Little is known about training and the practice of vaginal hysterectomy in many sub-Saharan Africa countries.
The aim of this study was to identify the clinical determinants of choice of hysterectomy route for benign conditions at the University Teaching Hospital in Yaoundé, Cameroon (UTHYC).
This was a retrospective cross-sectional study at the UTHYC from January 1, 2000 to December 31, 2008. Non-emergency hysterectomies for benign conditions were divided into two surgical approaches: vaginal and abdominal. Patients' files and registers were used for data collection. Variables of interest were socio-demographic, reproductive health, and clinical characteristics, including indications and surgical route. Analysis was performed using Epi-Info version 3.5.1. Logistic regression analysis was conducted to determine the association between clinical variables and surgical routes. Odds ratios with their 95% confidence intervals (CI) were calculated. The level of significance was set up at < 0.05.
One hundred and sixty-three women who underwent hysterectomy for benign conditions were included in the study. Thirty-seven (22.7%) were by vaginal route and 126 (77.3%) by abdominal route. Indications for hysterectomy were: cervical premalignant lesions, symptomatic uterine fibroids, prolapsed uterus, endometrial hyperplasia, recurrent cervical condyloma, and dysfunctional uterine bleeding. All 61 women with estimated uterine size of more than 12 weeks were operated on by abdominal route. At bivariate analysis, compared to women who had vaginal hysterectomy, factors associated with the choice of abdominal route were secondary/tertiary level of formal education, previous history of laparotomy/caesarean section, premenopausal status, age less than 50 years, and symptomatic uterine fibroids as surgical indication. At multivariate analysis, factors remaining independently associated with the choice of abdominal route were: age <50 years (AOR: 2.99 [1.9-4.71]), < 0.001); previous laparotomy/cesarean section (AOR: 2.95[2.13-4.08], = 0.001); premenopausal status (AOR: 1.55 [1.06-2.25]; = 0.001); and myoma as surgical indication (AOR: 7.49.4[3.2-14.4]; = 0.0001).
Less than a quarter of hysterectomies for benign conditions were performed vaginally. All patients with uterine sizes larger than 12 weeks had laparotomy. The determinants of the choice of the abdominal route included age less than 50 years, previous laparotomy/caesarean section, premenopausal status, and fibroid as surgical indication.
在撒哈拉以南非洲的许多国家，关于阴道子宫切除术的培训及实践情况鲜为人知。
本研究旨在确定喀麦隆雅温得大学教学医院（UTHYC）针对良性疾病选择子宫切除途径的临床决定因素。
这是一项于2000年1月1日至2008年12月31日在UTHYC进行的回顾性横断面研究。针对良性疾病的非急诊子宫切除术分为两种手术方式：经阴道和经腹。通过患者病历和登记册收集数据。感兴趣的变量包括社会人口统计学、生殖健康及临床特征，包括手术指征和手术途径。使用Epi-Info 3.5.1版本进行分析。进行逻辑回归分析以确定临床变量与手术途径之间的关联。计算比值比及其95%置信区间（CI）。显著性水平设定为<0.05。
本研究纳入了163例行良性疾病子宫切除术的女性。37例（22.7%）采用经阴道途径，126例（77.3%）采用经腹途径。子宫切除的指征包括：宫颈癌前病变、有症状的子宫肌瘤、子宫脱垂、子宫内膜增生、复发性宫颈湿疣及功能失调性子宫出血。所有61例估计子宫大小超过12周的女性均采用经腹途径手术。在双变量分析中，与经阴道子宫切除术的女性相比，与选择经腹途径相关的因素包括中等/高等正规教育程度、既往剖腹手术/剖宫产史、绝经前状态、年龄小于50岁以及有症状的子宫肌瘤作为手术指征。在多变量分析中，与选择经腹途径独立相关的因素包括：年龄<50岁（比值比：2.99[1.9 - 4.71]，<0.001）；既往剖腹手术/剖宫产史（比值比：2.95[2.13 - 4.08]，=0.001）；绝经前状态（比值比：1.55[1.06 - 2.25]；=0.001）；以及子宫肌瘤作为手术指征（比值比：7.49[3.2 - 14.4]；=0.0001）。
良性疾病子宫切除术中经阴道手术的比例不到四分之一。所有子宫大小大于12周的患者均接受了剖腹手术。选择经腹途径的决定因素包括年龄小于50岁、既往剖腹手术/剖宫产史、绝经前状态以及子宫肌瘤作为手术指征。
