Hammerbak-Andersen Marie, Klarskov Niels, Husby Karen R
Department of Obstetrics and Gynecology, Herlev and Gentofte University Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.
Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Int Urogynecol J. 2023 Oct;34(10):2495-2500. doi: 10.1007/s00192-023-05566-6. Epub 2023 May 22.
We aimed to evaluate the risk of reoperation and uterine (myometrial, endometrial, and cervical) and vaginal cancer after colpocleisis performed during the years 1977-2018. Furthermore, we also aimed to assess the development in colpocleisis procedures performed during the study period.
Danish nationwide registers covering operations, diagnoses, and life events can be linked on an individual level owing to the unique personal numbers of all Danish residents. We performed a nationwide historical cohort study including women born before year 2000 who underwent colpocleisis between 1977 and 2018 (N = 2,228) using the Danish National Patient Registry (DNPR). We followed the cohort until death/emigration/31 December 2018, whichever came first. Primary outcomes were number of pelvic organ prolapse (POP) operations performed after colpocleisis and uterine and vaginal cancer diagnosed after colpocleisis in a subgroup of women with the uterus in situ. This was assessed with cumulative incidences.
During follow-up (median 5.6 years) 6.5% and 8.2% underwent POP surgery within 2 and 10 years after colpocleisis respectively. Within 10 years after colpocleisis 0.5% (N = 8) were diagnosed with uterine or vaginal cancer in the subgroup of women with their uterus (N = 1,970). During the study time 37-80 women underwent colpocleisis yearly and the mean age increased (77.1 to 81.4 years).
Despite smaller studies showing no recurrence after colpocleisis, we found that 6.5% underwent reoperation within 2 years. Few women were diagnosed with uterine or vaginal cancer after colpocleisis. The increased age at the time of colpocleisis indicates changed attitudes regarding surgical treatment for elderly women with comorbidities.
我们旨在评估1977年至2018年间进行阴道封闭术后再次手术的风险以及子宫（肌层、内膜和宫颈）癌和阴道癌的发生风险。此外，我们还旨在评估研究期间阴道封闭术的发展情况。
由于所有丹麦居民都有唯一的个人身份号码，丹麦全国范围内涵盖手术、诊断和生活事件的登记册可以在个体层面上进行关联。我们利用丹麦国家患者登记处（DNPR）进行了一项全国性历史队列研究，纳入了2000年前出生且在1977年至2018年间接受阴道封闭术的女性（N = 2228）。我们对该队列进行随访直至死亡/移民/2018年12月31日，以先发生者为准。主要结局是阴道封闭术后盆腔器官脱垂（POP）手术的次数以及子宫原位的女性亚组中阴道封闭术后诊断出的子宫癌和阴道癌。这通过累积发病率进行评估。
在随访期间（中位时间5.6年），分别有6.5%和8.2%的女性在阴道封闭术后2年和10年内接受了POP手术。在子宫原位的女性亚组（N = 1970）中，阴道封闭术后10年内有0.5%（N = 8）被诊断出患有子宫癌或阴道癌。在研究期间，每年有37 - 80名女性接受阴道封闭术，平均年龄有所增加（从77.1岁增至81.4岁）。
尽管较小规模的研究显示阴道封闭术后无复发情况，但我们发现6.5%的女性在2年内接受了再次手术。阴道封闭术后很少有女性被诊断出患有子宫癌或阴道癌。阴道封闭术时年龄的增加表明对患有合并症的老年女性手术治疗的态度有所改变。
