Parazzini F, Negri E, La Vecchia C, Luchini L, Mezzopane R
Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy.
Obstet Gynecol. 1993 Mar;81(3):363-6.
To analyze the relation between hysterectomy with or without oophorectomy and the risk of subsequent ovarian cancer.
We have conducted a case-control study since 1983 in a network of general and university hospitals in the greater Milan area. The cases were 953 women aged less than 75 years with histologically confirmed epithelial ovarian cancer. Women younger than 75 years residing in the same geographic area and admitted for acute conditions to the same network of hospitals where the cases had been identified were eligible as controls. Potential controls were excluded if they had been admitted for gynecologic, hormonal, or neoplastic diseases or had previously undergone bilateral oophorectomy. A total of 2758 controls were interviewed.
Fifty-two cases (5.5%) and 215 controls (7.8%) reported a history of hysterectomy, including eight cases and 38 controls who also reported unilateral oophorectomy. In comparison with women with intact uterus and ovaries, the age-adjusted relative risk (RR) was 0.7 in both women who reported hysterectomy alone (95% confidence interval [CI] 0.5-0.9) and in those reporting hysterectomy plus unilateral oophorectomy, though the latter finding was not statistically significant (95% CI 0.3-1.4). The risk of ovarian cancer was inversely related with time from hysterectomy. Compared with women reporting no pelvic surgery, the RR was 0.9 (95% CI 0.4-1.7), 0.7 (0.3-1.6), 0.7 (0.3-1.4), and 0.5 (0.3-0.8), respectively, in women reporting hysterectomy within 4 years or less and 5-9, 10-14, and 15 years or more before interview.
Hysterectomy approximately halves the risk of ovarian cancer, possibly because of altered ovarian blood flow or the opportunity that hysterectomy provides for examining the ovaries.
分析子宫切除术伴或不伴卵巢切除术与后续卵巢癌风险之间的关系。
自1983年起，我们在大米兰地区的综合医院和大学医院网络中开展了一项病例对照研究。病例为953名年龄小于75岁、经组织学确诊为上皮性卵巢癌的女性。居住在同一地理区域、因急性病入住确诊病例所在医院网络的75岁以下女性符合作为对照的条件。如果潜在对照因妇科、激素或肿瘤疾病入院或此前接受过双侧卵巢切除术，则将其排除。共对2758名对照进行了访谈。
52例病例（5.5%）和215名对照（7.8%）报告有子宫切除史，其中8例病例和38名对照还报告有单侧卵巢切除史。与子宫和卵巢均完整的女性相比，仅报告子宫切除的女性以及报告子宫切除加单侧卵巢切除的女性，年龄调整后的相对风险（RR）均为0.7，不过后者的结果无统计学意义（95%置信区间[CI]0.3 - 1.4）。卵巢癌风险与子宫切除后的时间呈负相关。与未进行盆腔手术的女性相比，在访谈前4年及以内、5 - 9年、10 - 14年以及15年及以上进行子宫切除的女性，RR分别为0.9（95%CI 0.4 - 1.7）、0.7（0.3 - 1.6）、0.7（0.3 - 1.4）和0.5（0.3 - 0.8）。
子宫切除术可使卵巢癌风险降低约一半，可能是由于卵巢血流改变或子宫切除术为检查卵巢提供了机会。
