Persistence of Symptoms After Total vs Supracervical Hysterectomy in Women with Histopathological Diagnosis of Adenomyosis
Persistence of Symptoms After Total vs Supracervical Hysterectomy in Women with Histopathological Diagnosis of Adenomyosis
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DOI：
10.1016/j.jmig.2018.09.002
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发表时间：
2019-07-01
影响因子：
4.1
通讯作者：
Cohen, Sarah L.
中科院分区：
文献类型：
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作者：
Ajao, Mobolaji O.;Brito, Luiz G. Oliveira;Cohen, Sarah L.
研究目的：根据子宫切除术时保留或切除子宫颈的情况，比较子宫腺肌病女性的症状持续情况。设计：回顾性队列研究和随访调查（加拿大工作组分类 xx）。地点：马萨诸塞州波士顿的三级护理学术医院。患者：2008 年至 2012 年期间在布莱根和 2012 年因良性指征接受腹腔镜子宫切除术的女性 (n = 1580)妇女福克纳医院和布莱根妇女医院。干预：回顾性图表审查和随访调查。测量和主要结果：在接触的 1580 名妇女中，762 名 (48%) 回应了术后症状缓解调查。在这 762 名女性中，有 623 名同意参加这项研究。更年期妇女或接受过双侧输卵管卵巢切除术的妇女被排除在外。其余 443 名女性中，有 171 名 (39%) 通过子宫组织病理学评估发现子宫腺肌病。与没有子宫腺肌病的女性相比，患有子宫腺肌病的女性平均年龄更大（平均年龄，46.6 +/- 6.8 岁 vs 45.0 +/- 5.5 岁；p = .009），并且更有可能报告异常出血和疼痛导致子宫切除术（87.7% vs 79.8%；p = .03 和 64.9% vs 51.4%；p = .009，分别）。两组的全子宫切除率和宫颈上子宫切除率相似。手术后，患有子宫腺肌病的女性比没有子宫腺肌病的女性报告持续性疼痛的可能性更小（调整后的比值比 [aOR]，0.43；95% 置信区间 [CI]，0.20-0.93；p = 0.03）。两组的持续出血情况相似（aOR，0.97；95% CI，0.49-1.93；p = .94）。在患有子宫腺肌病的女性中，多变量逻辑回归显示子宫切除术时宫颈切除或保留的症状持续时间没有差异。结论：与没有子宫腺肌病的女性相比，经组织病理学证实患有子宫腺肌病的女性在子宫切除术后报告持续性疼痛的可能性较小。保留子宫颈似乎不会增加症状持续的风险或术后患者满意度。 (C) 2018 年 AAGL。版权所有。
Study Objective: To compare symptom persistence in women with adenomyosis based on retention or removal of the cervix at the time of hysterectomy.Design: Retrospective cohort study and follow-up survey (Canadian Task Force classification xx).Setting: Tertiary care academic hospital in Boston, Massachusetts.Patients: Women (n = 1580) who underwent laparoscopic hysterectomy for benign indications between 2008 and 2012 at Brigham and Women's Faulkner Hospital and Brigham and Women's Hospital.Intervention: Retrospective chart review and follow-up survey.Measurements and Main Results: Among the 1580 women contacted, 762 (48%) responded to the postoperative symptom resolution survey. Of these 762 women, 623 agreed to participate in the study. Menopausal women or those who had undergone bilateral salpingo-oophorectomy were excluded. Adenomyosis was identified on histopathologic evaluation of the uterus in 171 of the remaining 443 women (39%). Compared with women without adenomyosis, those with adenomyosis were older on average (mean age, 46.6 +/- 6.8 years vs 45.0 +/- 5.5 years; p = .009) and more likely to report that abnormal bleeding and pain led to their hysterectomy (87.7% vs 79.8%; p = .03 and 64.9% vs 51.4%; p = .009, respectively). The rates of total and supracervical hysterectomies were similar in the 2 groups. Following surgery, women with adenomyosis were less likely than those without adenomyosis to report persistent pain (adjusted odds ratio [aOR], 0.43; 95% confidence interval [CI], 0.20-0.93; p = .03). Persistent bleeding was similar in the 2 groups (aOR, 0.97; 95% CI, 0.49-1.93; p = .94). Among women with adenomyosis, multivariable logistic regression showed no difference in persistence of symptoms with cervical removal or retention at the time of hysterectomy.Conclusion: Compared with women without adenomyosis, those with histopathologically proven adenomyosis were less likely to report persistent pain following hysterectomy. Retention of the cervix does not appear to increase the risk of symptom persistence or postprocedure patient satisfaction. (C) 2018 AAGL. All rights reserved.