Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Department of Obstetrics and Gynecology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
J Gynecol Oncol. 2023 Mar;34(2):e20. doi: 10.3802/jgo.2023.34.e20. Epub 2022 Dec 21.
This study aimed to identify the risk factors for genitourinary fistulas and delayed fistula recognition after radical hysterectomy for cervical cancer.
This study was a retrospective analysis of data collected in the Major Surgical complications of Cervical Cancer in China (MSCCCC) database from 2004-2016. Data on sociodemographic characteristics, clinical characteristics, and hospital characteristics were extracted. Differences in the odds of genitourinary fistula development were investigated with multivariate logistic regression analyses, and differences in the time to recognition of genitourinary fistula were assessed by Kruskal-Wallis test.
In this study, 23,404 patients met the inclusion criteria. Surgery in a cancer center, a women's and children's hospital, a facility in a first-tier city, or southwest region, stage IIA, type C1 hysterectomy, laparoscopic surgery and ureteral injury were associated with a higher risk of ureterovaginal fistula (UVF) (p<0.050). Surgery in southwest region, bladder injury and laparoscopic surgery were associated with greater odds of vesicovaginal fistula (VVF) (p<0.050). Surgery at cancer centers and high-volume hospitals was associated with an increase in the median time to UVF recognition (p=0.016; p=0.005). International Federation of Gynecology and Obstetrics (FIGO) stage IIA1-IIB was associated with delayed recognition of VVF (p=0.040).
Intraoperative urinary tract injury and surgical approach were associated with differences in the development of UVFs and VVFs. Patients who underwent surgery in cancer centers and high-volume hospitals were more likely to experience delayed recognition of UVF. Patients with FIGO stage IIA1-IIB disease were more likely to experience delayed recognition of VVF.
本研究旨在确定宫颈癌根治性子宫切除术后发生泌尿生殖瘘和延迟识别泌尿生殖瘘的风险因素。
本研究为 2004 年至 2016 年中国宫颈癌重大手术并发症（MSCCCC）数据库中收集的数据的回顾性分析。提取社会人口统计学特征、临床特征和医院特征数据。采用多变量逻辑回归分析探讨泌尿生殖瘘发展的几率差异，并采用 Kruskal-Wallis 检验评估泌尿生殖瘘识别时间的差异。
在本研究中，23404 名患者符合纳入标准。在癌症中心、妇女儿童医院、一线城市或西南地区的医院进行手术、ⅡA 期、C1 型子宫切除术、腹腔镜手术和输尿管损伤与输尿管阴道瘘（UVF）风险增加相关（p<0.050）。西南地区手术、膀胱损伤和腹腔镜手术与更大的膀胱阴道瘘（VVF）几率相关（p<0.050）。在癌症中心和高容量医院进行手术与 UVF 识别中位数时间的增加相关（p=0.016；p=0.005）。国际妇产科联合会（FIGO）ⅡA1-ⅡB 期与 VVF 的延迟识别相关（p=0.040）。
术中尿路损伤和手术方法与 UVF 和 VVF 的发展存在差异。在癌症中心和高容量医院接受手术的患者更有可能出现 UVF 的延迟识别。FIGO ⅡA1-ⅡB 期疾病的患者更有可能出现 VVF 的延迟识别。
