Risk factors for pelvic organ prolapse repair after hysterectomy
Risk factors for pelvic organ prolapse repair after hysterectomy
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DOI：
10.1097/01.aog.0000278567.37925.4e
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发表时间：
2007-09-01
影响因子：
7.2
通讯作者：
Boulvain, Michel
中科院分区：
文献类型：
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作者：
Daellenbach, Patrick;Kaelin-Gambirasio, Isabelle;Boulvain, Michel
目的：评估子宫切除术后盆腔器官脱垂修复的发生率并确定其危险因素。我们确定了1982年至2002年在我们妇科接受子宫切除术的6,214名妇女。病例（n=114）为1982年1月至2005年12月子宫切除术后需要盆腔器官脱垂手术的女性。对照组（n=236）是从同一队列中随机选择的女性，在同一时期不需要盆腔器官手术。我们对104例患者和190例对照者进行了单变量和多变量分析，以确定子宫切除术后脱垂修复相关的变量。结果：子宫切除术后需要手术矫正的盆腔器官脱垂的发生率为1.3/1000女性年。初次子宫切除术后脱垂的妇女，其脱垂修复的风险高4.7倍，术前脱垂2级或以上的妇女，其脱垂修复的风险高8.0倍。风险因素包括术前脱垂2级或以上（校正比值比[OR] 12.6，95%置信区间[CI] 4.6-34.7），既往盆腔器官脱垂或尿失禁手术（调整OR 7.9，95% CI 1.3-48.2），阴道分娩史（调整OR 5.0，95% CI 1.3-19.7）和性活动（调整OR 6.2，95% CI 2.7-14.5）。阴道子宫切除术是不是一个危险因素时，术前脱垂考虑（调整OR 0.7，95%CI 0.4-1.1）。结论：术前盆腔器官脱垂和其他相关因素盆底虚弱子宫切除术后的盆底修复显着相关。阴道子宫切除术不是危险因素。
OBJECTIVE: To estimate the incidence and identify the risk factors for pelvic organ prolapse repair after hysterectomy.METHODS: We conducted a case-control study. We identified 6,214 women who underwent hysterectomy in our gynecology department from 1982 to 2002. Cases (n=114) were women who required pelvic organ prolapse surgery after hysterectomy from January 1982 through December 2005. Controls (n=236) were women randomly selected from the same cohort who did not require pelvic organ surgery during the same period. We performed a univariable and a multivariable analysis among 104 cases and 190 controls to identify the variables associated with prolapse repair after hysterectomy.RESULTS: The incidence of pelvic organ prolapse that required surgical correction after hysterectomy was 1.3 per 1,000 women-years. The risk of prolapse repair was 4.7 times higher in women whose initial hysterectomy was indicated by prolapse and 8.0 times higher if preoperative prolapse grade 2 or more was present. Risk factors included preoperative prolapse grade 2 or more (adjusted odds ratio [OR] 12.6, 95% confidence interval [CI] 4.6-34.7), previous pelvic organ prolapse or urinary incontinence surgery (adjusted OR 7.9, 95% CI 1.3-48.2), history of vaginal delivery (adjusted OR 5.0, 95% CI 1.3-19.7), and sexual activity (adjusted OR 6.2, 95% CI 2.7-14.5). Vaginal hysterectomy was not a risk factor when preoperative prolapse was taken into account (adjusted OR 0.7, 95% CI 0.4-1.1).CONCLUSION: Preoperative pelvic organ prolapse and other factors related to pelvic floor weakness were significantly associated with subsequent pelvic floor repair after hysterectomy. Vaginal hysterectomy was not a risk factor.