Lepine L A, Hillis S D, Marchbanks P A, Koonin L M, Morrow B, Kieke B A, Wilcox L S
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
MMWR CDC Surveill Summ. 1997 Aug 8;46(4):1-15.
PROBLEM/CONDITION: In the United States, approximately 600,000 hysterectomies are performed each year, and the procedure is the second most frequently performed major surgical procedure among reproductive-aged women.
1980-1993.
This surveillance system uses data obtained from CDC's National Hospital Discharge Survey (NHDS) to describe the epidemiology of hysterectomy. The NHDS is an annual probability sample of discharges from non-Federal, short-stay hospitals in the United States.
In the United States during 1980-1993, an estimated 8.6 million women aged > or =15 years had a hysterectomy. The overall rate of hysterectomy declined slightly from 1980 (7.1 hysterectomies per 1,000 women) to 1987 (6.6 per 1,000 women). The redesign of the NHDS in 1988 resulted in a decrease in estimated rates (i.e., the average annual rate for 1988-1993 was 5.5 per 1,000 women). Rates differed by age, with women aged 40-44 years most likely to have this procedure. Overall annual rates of hysterectomy did not differ significantly by race. The diagnosis most often associated with hysterectomy was uterine leiomyoma; during 1988-1993, this diagnosis accounted for 62% of hysterectomies among black women, 29% among white women, and 45% among women of other races. During 1988-1993, the percentage of hysterectomies performed by the vaginal route increased significantly; furthermore, an increasingly higher percentage of vaginal hysterectomies were accompanied by bilateral oophorectomy. From 1991 through 1993, laparoscopy was associated more frequently with vaginal hysterectomy than in previous years.
The rate of hysterectomy decreased slightly during the first half of the 14-year surveillance period, then leveled off during the second half. The increase in simultaneous coding of laparoscopy and vaginal hysterectomy on hospital discharge forms probably reflected the growing use of laparoscopically assisted vaginal hysterectomy.
Continued surveillance for hysterectomy will enable changes in clinical practice (e.g., the use of LAVH) to be identified, and information derived from the surveillance system may assist in directing biomedical assessment priorities (e.g., to determine the reasons for race-specific differences in the prevalence of uterine leiomyoma).
问题/状况：在美国，每年约有60万例子宫切除术，该手术是育龄妇女中第二常见的大型外科手术。
1980 - 1993年。
该监测系统使用从美国疾病控制与预防中心的全国医院出院调查（NHDS）获取的数据来描述子宫切除术的流行病学情况。NHDS是美国非联邦短期住院医院出院情况的年度概率样本。
在1980 - 1993年期间的美国，估计有860万年龄≥15岁的女性接受了子宫切除术。子宫切除术的总体发生率从1980年（每1000名女性中有7.1例子宫切除术）略微下降至1987年（每1000名女性中有6.6例）。1988年NHDS的重新设计导致估计发生率下降（即1988 - 1993年的年均发生率为每1000名女性中有5.5例）。发生率因年龄而异，40 - 44岁的女性最有可能接受该手术。子宫切除术的总体年发生率在不同种族之间没有显著差异。与子宫切除术最常相关的诊断是子宫平滑肌瘤；在1988 - 1993年期间，该诊断在黑人女性的子宫切除术中占62%，在白人女性中占29%，在其他种族女性中占45%。在1988 - 1993年期间，经阴道途径进行的子宫切除术的百分比显著增加；此外，越来越高比例的经阴道子宫切除术伴有双侧卵巢切除术。从1991年到1993年，腹腔镜检查与经阴道子宫切除术的关联比前几年更为频繁。
在14年监测期的前半段，子宫切除术的发生率略有下降，后半段趋于平稳。医院出院表格上腹腔镜检查和经阴道子宫切除术同时编码的增加可能反映了腹腔镜辅助经阴道子宫切除术的使用增加。
持续监测子宫切除术将有助于识别临床实践中的变化（例如腹腔镜辅助经阴道子宫切除术的使用情况），并且从监测系统获得的信息可能有助于指导生物医学评估的重点（例如确定子宫平滑肌瘤患病率种族差异的原因）。
