Vuorma S, Teperi J, Hurskainen R, Keskimäki I, Kujansuu E
Stakes, National Research and Development Centre for Welfare and Health, Health Services Research Unit, Helsinki, Finland.
Acta Obstet Gynecol Scand. 1998 Aug;77(7):770-6.
The study objective was to identify trends in the use of hysterectomy by nationwide register based analysis in Finland.
All women (n=89,069) undergoing hysterectomy in 1987-1995 according to the Finnish Hospital Discharge Register were the numerator. The annual denominator data were obtained from the population database of Statistics Finland.
From 1987 to 1992 the hysterectomy rate increased by 22%, from 340 to 414 per 100,000 females, almost half of this being attributable to the changing age structure. From 1993 on, ambiguity in coding laparoscopically assisted vaginal hysterectomies prohibited detailed analyses. However, the overall trend continued at least among women 50 years and over until 1995. The age-adjusted 12% increase from 1987 to 1992 coincided with a rapid increase in operation rates in postmenopausal groups (60% or more among women aged 55 59 and 70-79 years). Among women aged 55-64 years, operations for fibroids and uterine bleeding more than doubled, suggesting an influence of increased use of estrogen replacement therapy. Among all women, operations due to bleeding disorders and genital prolapse showed the largest increase (41% and 42% respectively). Bilateral oophorectomy became more common in all age groups over 46 years.
There was a modest increase in the overall hysterectomy rate. However, the operation became far more common in postmenopausal women, possibly due to the growing use of estrogen replacement therapy. Register data can be used for describing changes in clinical practice, but other methods are needed to confirm the causal relationships underlying the changes.
本研究目的是通过基于全国登记系统的分析确定芬兰子宫切除术的使用趋势。
以1987 - 1995年根据芬兰医院出院登记系统接受子宫切除术的所有女性（n = 89,069）作为分子。年度分母数据来自芬兰统计局的人口数据库。
1987年至1992年，子宫切除率上升了22%，从每10万名女性340例增至414例，其中近一半归因于年龄结构的变化。从1993年起，腹腔镜辅助阴道子宫切除术编码的模糊性妨碍了详细分析。然而，总体趋势至少在50岁及以上女性中持续到1995年。1987年至1992年经年龄调整后增加12%，这与绝经后组手术率的快速上升相一致（55 - 59岁和70 - 79岁女性中上升60%或更多）。在55 - 64岁女性中，因子宫肌瘤和子宫出血进行的手术增加了一倍多，这表明雌激素替代疗法使用增加产生了影响。在所有女性中，因出血性疾病和生殖器脱垂进行的手术增加幅度最大（分别为41%和42%）。双侧卵巢切除术在46岁以上所有年龄组中变得更为常见。
子宫切除术总体发生率有适度上升。然而，该手术在绝经后女性中变得更为常见，可能是由于雌激素替代疗法使用增加。登记数据可用于描述临床实践中的变化，但需要其他方法来证实这些变化背后的因果关系。
