Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan.
Department of Real-world Evidence, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Eur J Obstet Gynecol Reprod Biol. 2024 Nov;302:196-200. doi: 10.1016/j.ejogrb.2024.09.010. Epub 2024 Sep 12.
Uterine rupture, though rare, poses significant risks to both mother and child. Its occurrence varies globally, with a noted 0.015% prevalence in Japan. This condition usually requires surgical intervention, either as uterine repair or hysterectomy. Past studies, largely single-center and outdated, offer limited insights into these treatment options. To assess and compare the clinical outcomes of repair and hysterectomy for uterine rupture among patients included in a large inpatient database in Japan.
We analyzed the Diagnosis Procedure Combination inpatient database from July 2010 to March 2022. Patients with uterine rupture who underwent uterine repair or hysterectomy were extracted. Patient characteristics, in-hospital care, and outcomes were compared between the uterine repair group and the hysterectomy group. Main outcomes are reoperation during hospitalization, total volume of blood transfusion, complications (bowel injury, urinary tract injury, wound infection, deep vein thrombosis, or pulmonary embolism), maternal mortality, and postoperative length of stay.
We identified 644 patients with uterine rupture. Of those, 287 (44.6 %) underwent uterine repair and 357 (55.4 %) underwent hysterectomy. The hysterectomy group was significantly older, had significantly more comorbidities, and had a significantly higher prevalence of consciousness impairment than the uterine repair group. Compared with the uterine repair group, the hysterectomy group required significantly more in-hospital care and had a significantly greater incidence of reoperation (1.0 % versus 6.4 %; P<0.001). Other complications were not significantly different between the groups. The hysterectomy group had significantly more blood transfusions and a significantly longer postoperative length of hospital stay than the uterine repair group. The results remained consistent even after the adjusted analysis.
This study highlights the differences between repair and hysterectomy for uterine rupture, providing valuable insights for clinical decision-making in these cases.
尽管罕见，但子宫破裂会给母婴带来重大风险。其在全球的发生率有所不同，在日本为 0.015%。这种情况通常需要手术干预，包括子宫修复或子宫切除术。过去的研究主要是单中心的且已过时，对这些治疗选择的了解有限。本研究旨在评估和比较在日本大型住院患者数据库中纳入的子宫破裂患者行子宫修复和子宫切除术的临床结局。
我们分析了 2010 年 7 月至 2022 年 3 月的诊断程序组合住院患者数据库。提取行子宫修复或子宫切除术的子宫破裂患者。比较子宫修复组和子宫切除术组患者的特征、住院期间的护理和结局。主要结局为住院期间再次手术、总输血量、并发症（肠损伤、泌尿道损伤、伤口感染、深静脉血栓形成或肺栓塞）、产妇死亡率和术后住院时间。
我们共纳入了 644 例子宫破裂患者，其中 287 例（44.6%）行子宫修复术，357 例（55.4%）行子宫切除术。子宫切除术组年龄较大，合并症更多，意识障碍的发生率显著高于子宫修复组。与子宫修复组相比，子宫切除术组需要更多的住院护理，再次手术的发生率显著更高（1.0%比 6.4%；P<0.001）。两组其他并发症无显著差异。子宫切除术组的输血量显著多于子宫修复组，术后住院时间也显著更长。调整分析后结果仍一致。
本研究强调了子宫破裂行子宫修复和子宫切除术之间的差异，为这些病例的临床决策提供了有价值的信息。
