Wagenius Johanna, Ehrström Sophia, Källén Karin, Baekelandt Jan, Stuart Andrea
Institute of Clinical Sciences, Department of Obstetrics and Gynecology, Lund University, Lund, Sweden.
Department of Obstetrics and Gynecology, Helsingborg Hospital, Helsingborg, Sweden.
Acta Obstet Gynecol Scand. 2025 May;104(5):958-967. doi: 10.1111/aogs.15099. Epub 2025 Mar 18.
The rate of vaginal hysterectomies is declining globally. We investigated surgical techniques, outcomes, and costs in a large national cohort of benign hysterectomies with prerequisites for vaginal surgery.
A retrospective register-based cohort study with benign hysterectomies in the Swedish GynOp registry 2014-2023 (n = 17 804). Inclusion criteria were non-prolapse, non-endometriosis with uterus weight <300 g. The cohort was divided into a low-risk and a standard group, with the low-risk group having optimal conditions for vaginal hysterectomy: no previous caesarian section (CS), no previous abdominal surgery, Body Mass Index (BMI) <30, and no nulliparous patients. Surgical outcomes were quantified using crude and adjusted risk ratios (RR, ARR). Costs were calculated and compared between abdominal (AH), laparoscopic (LH), robot-assisted (RH), and vaginal hysterectomies (VH).
The rate of AH and VH decreased during the period studied. RH increased and was the most common surgical technique 2021-2023 (33.2%). VH had the shortest surgical time and was the cheapest method. In the low-risk group, 25.2% of the patients were operated on vaginally. AH had more postoperative complications and longer hospitalization compared to VH in the low-risk group. LH had less severe intraoperative complications, ARR = 0.38 (95% CI 0.17-0.86) but more mild postoperative complications, ARR = 1.24 (95% CI 1.05-1.46) compared to VH in the low-risk group. LH had more conversions, ARR = 1.46 (95% CI 1.00-2.12), longer surgical time, ARR = 2.73 (95% CI 2.46-3.00) and longer hospital stay, ARR = 1.26 (95% CI 1.12-1.43) compared to VH. Mild (ARR = 0.33, 95% CI 0.16-0.66) and severe (ARR = 0.17, 95% CI 0.05-0.58) intraoperative complications and bleeding >500 mL (ARR = 0.12, 95% CI 0.04-0.34) were less common in RH versus VH in the low-risk group. There were no differences between RH and VH regarding postoperative complications and reoperations. Surgical time <45 min was less common in RH versus VH (ARR = 0.47, 95% CI 0.42-0.54) and RH had a significantly longer postoperative hospital stay (ARR = 1.16, 95% CI 1.02-1.33).
A decline of vaginal hysterectomies in Sweden 2014-2023 among patients with prerequisites for vaginal surgery was shown. VH was the cheapest method with few postoperative complications and short hospitalization. Our results support the vaginal route in low-risk hysterectomies.
全球范围内阴道子宫切除术的比例正在下降。我们在一个大型全国性良性子宫切除术队列中研究了手术技术、结果和成本，这些手术均具备阴道手术的先决条件。
一项基于瑞典GynOp登记处2014 - 2023年良性子宫切除术的回顾性队列研究（n = 17804）。纳入标准为非脱垂、非子宫内膜异位且子宫重量<300g。该队列分为低风险组和标准组，低风险组具备阴道子宫切除术的最佳条件：无既往剖宫产史、无既往腹部手术史、体重指数（BMI）<30且无未生育患者。手术结果采用粗风险比（RR）和调整风险比（ARR）进行量化。计算并比较了腹部子宫切除术（AH）、腹腔镜子宫切除术（LH）、机器人辅助子宫切除术（RH）和阴道子宫切除术（VH）的成本。
在所研究期间，AH和VH的比例下降。RH增加且是2021 - 2023年最常见的手术技术（33.2%）。VH手术时间最短且是最便宜的方法。在低风险组中，25.2%的患者接受了阴道手术。与低风险组的VH相比，AH术后并发症更多且住院时间更长。与低风险组的VH相比，LH术中并发症较轻，ARR = 0.38（95%CI 0.17 - 0.86），但术后轻度并发症更多，ARR = 1.24（95%CI 1.05 - 1.46）。与VH相比，LH的中转率更高，ARR = 1.46（95%CI 1.00 - 2.12），手术时间更长，ARR = 2.73（95%CI 2.46 - 3.00），住院时间更长，ARR = 1.26（95%CI 1.12 - 1.43）。与低风险组的VH相比，RH术中轻度（ARR = 0.33，95%CI 0.16 - 0.66）和重度（ARR = 0.17，95%CI 0.05 - 0.58）并发症以及出血>500mL（ARR = 0.12，95%CI 0.04 - 0.34）的情况较少见。RH和VH在术后并发症和再次手术方面无差异。与VH相比，RH手术时间<45分钟的情况较少见（ARR = 0.47，95%CI 0.42 - 0.54），且RH术后住院时间明显更长（ARR = 1.16，95%CI 1.02 - 1.33）。
研究表明，2014 - 2023年瑞典具备阴道手术先决条件的患者中，阴道子宫切除术的比例有所下降。VH是最便宜的方法，术后并发症少且住院时间短。我们的结果支持在低风险子宫切除术中采用阴道途径。
