Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden.
Acta Obstet Gynecol Scand. 2022 Oct;101(10):1048-1056. doi: 10.1111/aogs.14437. Epub 2022 Aug 25.
Hysterectomy is one of the most common major surgical procedures in women. The effects of hysterectomy on pelvic floor and sexual function are uncertain. Our objective was to investigate the effects of hysterectomy for benign indications on pelvic floor and sexual function and to compare different modes of surgery.
We performed a prospective clinical cohort study. In all, 260 women scheduled for hysterectomy answered validated questionnaires (Pelvic Floor Impact Questionnaire, Pelvic Floor Distress Inventory and Female Sexual Function Index). Participants were followed 6 months and 1 year after surgery. Data were analyzed using nonparametric statistics and mixed effect models.
Women with subtotal hysterectomy, vaginal hysterectomy, laparoscopic assisted vaginal hysterectomy, and previous prolapse/incontinence surgery were excluded from further analysis, leaving the remaining cohort to 242 patients. The response rate at 6 months and 1 year follow-up was 180/242 (74.3%) and 169/242 (69.8%), respectively. There was an improvement of pelvic floor function at both follow-ups; mean score of Pelvic Floor Impact Questionnaire at baseline was 42.5 (51.7), at 6 months 19.9 (42.2) and at 1 year 23.7 (50.3) (p < 0.001). The mean score of Pelvic Floor Distress Inventory at baseline was 69.6 (51.1), at 6 months 49 (43.2) and at 1 year 49 (43.2) (p < 0.001). There was an improvement of sexual function after 6 months (mean score of Female Sexual Function Index at baseline 17.9 [SD 11.7] and at 6 months 21.0 [SD 11.7]) (p < 0.001). There was no difference in pelvic floor or sexual function when comparing surgical techniques.
Robotic assisted laparoscopic hysterectomy, laparoscopic hysterectomy and abdominal hysterectomy improve pelvic floor function to the same extent at 6 months and 1 year after surgery. There was an overall improvement of sexual function 6 months after hysterectomy, but this did not persist after 1 year.
子宫切除术是女性最常见的主要外科手术之一。子宫切除术对盆底和性功能的影响尚不确定。我们的目的是研究良性指征下子宫切除术对盆底和性功能的影响，并比较不同的手术方式。
我们进行了一项前瞻性临床队列研究。共有 260 名计划接受子宫切除术的女性回答了经过验证的问卷（盆底冲击问卷、盆底窘迫量表和女性性功能指数）。参与者在手术后 6 个月和 1 年进行随访。使用非参数统计和混合效应模型进行数据分析。
接受次全子宫切除术、经阴道子宫切除术、腹腔镜辅助经阴道子宫切除术以及既往脱垂/尿失禁手术的女性被排除在进一步分析之外，因此剩余队列为 242 名患者。6 个月和 1 年随访时的应答率分别为 180/242（74.3%）和 169/242（69.8%）。盆底功能在两次随访中均有所改善；基线时盆底冲击问卷的平均评分分别为 42.5（51.7）、6 个月时为 19.9（42.2）和 1 年时为 23.7（50.3）（p<0.001）。基线时盆底窘迫量表的平均评分分别为 69.6（51.1）、6 个月时为 49（43.2）和 1 年时为 49（43.2）（p<0.001）。6 个月后性功能有所改善（基线时女性性功能指数平均评分为 17.9[SD 11.7]，6 个月时为 21.0[SD 11.7]）（p<0.001）。比较手术技术时，盆底或性功能无差异。
机器人辅助腹腔镜子宫切除术、腹腔镜子宫切除术和腹式子宫切除术在术后 6 个月和 1 年均能同等程度地改善盆底功能。子宫切除术后 6 个月整体性功能有所改善，但 1 年后并未持续。
