Incidental urinary tract injury and the formation of vesicovaginal fistula at the time of hysterectomy for benign indications.
Incidental urinary tract injury and the formation of vesicovaginal fistula at the time of hysterectomy for benign indications.
复制标题
良性子宫切除术时意外的尿路损伤和膀胱阴道瘘的形成。
DOI：
10.1007/s00192-022-05367-3
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发表时间：
2023
影响因子：
1.8
通讯作者：
Giri,Ayush
中科院分区：
文献类型：
--
作者：
Butler,BrandyM;Adam,RonyA;Giri,Ayush
介绍和假设子宫切除术类型、腹腔镜使用和膀胱阴道瘘（VVF）之间的关系目前尚不清楚，这对确定手术途径和提供充分的患者咨询是有用的。本研究的目的是评价使用腹腔镜辅助、公认的术中尿路损伤和随后的VVF修复之间的关联程度，并量化子宫切除术类型的瘘修复和损伤检测的任何差异。最后，我们试图确定子宫切除术的类型是否是一个独立的损伤identifiation.MethodsWe修复VVF的风险因素进行了回顾性队列研究，利用医疗保健成本和利用项目数据库检查良性子宫切除术在加州，纽约和佛罗里达从2005-2011年。多变量Logistic回归模型被用来评估子宫切除术类型之间的关联，报告的伤害和VVF.Results581,395合格的子宫切除术，尿路损伤发生在6702例（1.15%）和640例患者发展VVF（0.11%）。报告有损伤的患者发生VVF的可能性是无损伤患者的20倍（OR = 20.6;分别为1.96%和0.089%）。如果涉及腹腔镜手术（OR = 30），则报告的损伤与VVF发展之间的相关性比不涉及腹腔镜手术（OR = 17）更强。接受腹腔镜手术的患者报告损伤的可能性较低（OR = 0.6），但更有可能接受VVF修复（OR = 1.5）。这种与VVF修复的关联独立于损伤鉴定。发展VVF的患者更有可能经历了全腹子宫切除术相比，其他子宫切除types.ConclusionsLaparoscopy是一个独立的危险因素，需要随后的VVF修复，独立的子宫切除术类型和存在术中公认的尿路损伤。
Introduction and hypothesisThe association between hysterectomy type, laparoscopy use and vesicovaginal fistula (VVF) is currently unclear and would be useful to determine route of surgery and provide adequate patient counseling. The objective of this study was to evaluate the magnitude of association between the use of laparoscopic assistance, recognized intraoperative urinary tract injury and subsequent VVF repair and to quantify any differences in fistula repair and injury detection by hysterectomy type. Lastly, we sought to determine whether the type of hysterectomy is a risk factor for VVF repair independent of injury identification.MethodsWe performed a retrospective cohort study utilizing the Healthcare Cost and Utilization Project database examining benign hysterectomies performed in California, New York and Florida from 2005–2011. Multivariable logistic regression models were used to evaluate associations among hysterectomy type, reported injury and VVF.ResultsOf 581,395 eligible hysterectomies, urinary tract injuries occurred in 6702 patients (1.15%) and 640 patients developed VVF (0.11%). Patients with reported injury were 20-fold more likely to develop VVF than those without (OR = 20.6; 1.96% vs. 0.089% respectively). The association between reported injury and VVF development was stronger if laparoscopy was involved (OR = 30) than if it was not (OR = 17). Patients undergoing laparoscopic procedures were less likely to have injury reported (OR = 0.6) but more likely to undergo VVF repair (OR = 1.5). This association with VVF repair was independent of injury identification. Patients developing VVF were more likely to have undergone total abdominal hysterectomy compared to other hysterectomy types.ConclusionsLaparoscopy is an independent risk factor for the need for subsequent VVF repair, independent of hysterectomy type and presence of intraoperatively recognized urinary tract injury.