Hysterectomy and socioeconomic position in Rome,Italy

STUDY OBJECTIVE: There exists conflicting evidence regarding the higher risk of hysterectomy among women of a lower educational and economic level. This study aims to assess whether in Italy socioeconomic level is related to hysterectomy undertaken for different medical reasons. DESIGN: An area based index was used to assign socieconomic status (SES; four levels defined) to 3141 women (aged 35 years or older) who underwent a hysterectomy in 1997 and were residing in Rome. Data were taken from hospital discharge records. Direct age standardised hospitalisation rates by SES level were calculated for overall hysterectomies and for those performed for either malignant or non-malignant causes. Statistical differences were detected using the ratios of standardised rates and the test for linear trend. MAIN RESULTS: The hysterectomy rate was 36.7 per 10 000 women aged 35 years or more. Hysterectomy for uterine leiomyoma accounted for 41% of all operations and was more frequent among women aged 35-49 years than for those aged 50 years or more (crude rates: 28.6 and 7.7 per 10 000, respectively). The risk of hysterectomy was 35% higher for the lowest SES group, compared with the highest group. No association was found between SES and hysterectomy rates for malignant causes, although less affluent women in age group 35-49 years had 87% higher risk of hysterectomy compared with most affluent women. The inverse association between SES and hysterectomy rates attributable to non-malignant causes was statistically significant for women aged 35-49 years but not for those aged 50 years or more. CONCLUSIONS: The inverse relation between hysterectomy and SES is largely attributable to benign disorders of the uterus, namely leiomyoma and prolapse. More affluent women may have a greater uptake of less invasive techniques for removing uterine leiomyoma compared with less affluent women, who are more likely to undergo unnecessary hysterectomies irrespective of their reproductive age.     

Readmission to hospital 5 years after hysterectomy or endometrial resection in a national cohort study

Objectives: To investigate the readmission experience of a large national prospective cohort of women up to 5 years after undergoing either transcervical resection of the endometrium (TCRE) or hysterectomy to assess reasons for readmission and whether TCRE can be viewed as a definitive substitute for hysterectomy.

Design and participants: Data are from the VALUE/MISTLETOE prospective national cohort studies of hysterectomy and TCRE respectively. 5294 women who underwent hysterectomy for dysfunctional uterine bleeding in 1994/5 and 4032 women who underwent TCRE in 1993/4 and who responded to postal questionnaires were included. Surgeons gathered operative details. Women completed postal follow up questionnaires at 3 and 5 years after surgery asking about readmission to hospital and reasons for readmission. Adjusted proportional hazard ratios were calculated for likelihood of readmission in each category comparing types of surgery.

Results: 41.7% of women undergoing hysterectomy and 44.6% of women undergoing TCRE experienced one or more readmissions to hospital overall within 5 years (adjusted hazard ratio for all readmissions (AHR) 0.87 (95% confidence interval (CI) 0.80 to 0.95)). 12.6% of hysterectomy patients and 30.3% of TCRE patients were readmitted for gynaecological reasons (AHR 0.40 (95% CI 0.33 to 0.48)). Rates of readmission for gynaecological reasons were similar up to 6 months but were markedly reduced for hysterectomy compared with TCRE patients towards the end of the follow up period (AHR for readmission at 3–5 years 0.28 (95% CI 0.20 to 0.39)).

Conclusions: There are differences in the pattern of readmission to hospital after hysterectomy and TCRE for dysfunctional uterine bleeding. Women undergoing a hysterectomy are less likely to be readmitted to hospital up to 5 years after their operation overall, and are significantly less likely to be readmitted for reasons related to their operation, particularly for gynaecological reasons. Hysterectomy appears to be a more definitive operation. The different options for surgery for dysfunctional uterine bleeding are not interchangeable; they represent different patterns of care. Information should be available to women and practitioners to inform choices between these options.

     

产科子宫切除术43例临床分析

目的:探讨子宫切除术在抢救产科大出血中的应用价值以及降低产科子宫切除术的可能性。方法:对产科近15年间所做的产科子宫切除术43例做了回顾性分析。结果:产科子宫切除术的发生率为0.15%,子宫切除的主要指征为D IC、子宫收缩乏力、胎盘因素、剖宫产术后子宫切口感染、子宫破裂。相关因素分析显示:孕产次、多胎妊娠、分娩方式等因素与产科子宫切除术相关。结论:产科子宫切除术是治疗产科急性大出血的有效措施之一,做好计划生育和孕产妇监护,正确掌握剖宫产指征,可以有效降低产科子宫切除术发生率。     

近10年子宫切除的原因分析

目的:探讨近10年子宫切除的原因。方法:近10年我院实施子宫切除术妇女2697例,分析手术首要指征和患者年龄。结果:①切除原因为子宫肌瘤62.6%,子宫腺肌病11.0%,子宫脱垂9.5%,恶性肿瘤7.9%,随后是卵巢良性肿瘤、功血、子宫内膜异位症、盆腔炎症、产科因素及CIN。②子宫切除高峰年龄在41~50岁,21~60岁各年龄组子宫肌瘤是首要原因,61~90岁3个年龄组子宫脱垂为首要原因,21~30岁子宫切除前两位原因是子宫肌瘤37.1%(13/35)和宫颈癌31.4%(11/35)。结论:41~50岁是子宫切除的高峰年龄。60岁前、后子宫切除最主要原因分别是子宫肌瘤和子宫脱垂,21~30岁年轻女性宫颈癌是次于子宫肌瘤的子宫切除的重要因素。     

Prevalence corrected hysterectomy rates and probabilities in Utah

PURPOSE: A life table method is used for correcting hysterectomy rates and probabilities for prevalent cases of hysterectomies in the population. Both corrected and conventional hysterectomy rates and probabilities are reported. METHODS: Hysterectomy prevalence estimates are derived from cross-sectional hysterectomy and mortality using a life table method. Analysis is based on the Utah Hospital Discharge Data Base and State death certificates. RESULTS: Hysterectomy rates are strongly influenced by age, reaching 150 per 10,000 for ages 45-49 years. The corresponding corrected hysterectomy rate is 196. Differences between the corrected and uncorrected cause-specific hysterectomy rates tend to be most pronounced at their peaks, particularly later in life where the prevalence of hysterectomy is greatest. Probability of hysterectomy approaches slightly above 35% over the life span, whereas the corrected hysterectomy probability approaches 43%. Probability of hysterectomy in the next 10 years is 12.9% for women aged 35 years and 11.7% for women aged 45 years. Corresponding corrected hysterectomy probabilities are 14.3 and 15.1. Higher prevalence of hysterectomy in later ages explains the reverse in magnitude of the rates when the correction is applied to the hysterectomy rates. CONCLUSIONS: Conventional hysterectomy rates are underestimated, particularly in older age groups. A prevalence correction of the rates and probabilities is necessary to fully understand the potential health related consequences and impact of this medical procedure in the population.     

44例宫颈肌瘤手术探究

目的:探讨宫颈肌瘤的术式选择及手术途径。方法:对1995年1月2004年12月该院收治的44例宫颈肌瘤的手术途径、术式选择以及结果进行评估。结果:8例小型宫颈壁间及浆膜下肌瘤(<5 cm),采用经阴道推开膀胱或直肠剔除肌瘤是可行的,符合微创手术的特点;12例中等大宫颈肌瘤(510 cm)采用腹式不剔肌瘤,由健侧进入阴道穹窿切除子宫,能达到出血少,并发症少,保留足够阴道长度的目的;9例巨大宫颈肌瘤(>10 cm)采用先剔除肌瘤后切除子宫法;15例悬垂型肌瘤直接阴道摘除术。结论:宫颈肌瘤手术方式及手术途径因肌瘤大小、类型而不同,按上述方法可有效切除肌瘤及子宫,防止并发症发生。     

剖宫产术中大出血52例分析

目的探讨剖宫产术中大出血的原因及降低产科子宫切除率的可能性。方法对我院52例剖宫产术中大出血患者的临床资料进行回顾性分析。结果52例大出血中,胎盘因素占50%,宫缩乏力占42.31%,子宫切口裂伤出血占5.77%,羊水栓塞占1.92%。治疗结果中,子宫切除5例,占剖宫产术的0.105%(5/4766)。结论胎盘因素、宫缩乏力是剖宫产术中大出血的主要原因。一旦发生,应针对病因迅速采取有效止血方法,可降低产科子宫切除率。     

剖宫产术中大出血52例分析

目的探讨剖宫产术中大出血的原因及降低产科子宫切除率的可能性。方法对我院52例剖宫产术中大出血患者的临床资料进行回顾性分析。结果52例大出血中,胎盘因素占50％,宫缩乏力占42．31％,子宫切口裂伤出血占5．77％,羊水栓塞占1．92％。治疗结果中,子宫切除5例,占剖宫产术的0．105％（5／4766）。结论胎盘因素、宫缩乏力是剖宫产术中大出血的主要原因。一旦发生,应针对病因迅速采取有效止血方法,可降低产科子宫切除率。     

射频消融术治疗子宫良性病变的临床研究

目的 探讨射频消融术治疗子宫肌瘤、子宫腺肌瘤、功能失调性子宫出血(功血)等子宫良性病变的疗效.方法 对三所医院的1069例妇科射频治疗病人进行回访,比较其治疗前、后临床表现及B超的变化.结果 子宫肌瘤有效率为94.74%,子宫腺肌瘤为88.31%,功血为96.91%,宫颈糜烂为100.0%.结论 射频热凝固治疗子宫肌瘤(＜6.0cm)、子宫腺肌瘤、功血和宫颈糜烂时间短,见效快,疗效高,患者住院时间短,治疗费用低.     

绝经后阴道出血的相关因素分析

目的 探讨绝经后阴道出血的病因和诊断.方法 对2002年1月至2005年6月在深圳市人民医院诊治的376例绝经后阴道出血的患者进行回顾性分析.结果 炎症患者176例(46.81%);功能性子宫出血患者85例(22.61%);肿瘤患者79例(21.01%):其中良性肿瘤23例(29.11%),恶性肿瘤56例(70.89%);宫内节育器17例(4.52%);其他19例(5.05%);绝经10年内恶性肿瘤21例,绝经10年以上,恶性肿瘤35例,两者相比,恶性肿瘤的发生率有显著性差异(P＜0.01).结论 绝经后阴道出血的首要病因是炎症,其次是功血,肿瘤居第三位.绝经时限越长,恶性肿瘤的发病率越高.     

Hysterectomy use: the correspondence between self-reports and hospital records.

Studies of the relationship between hysterectomy use and sociodemographic factors tend to use self-reported data. In the current study, data were collected from a representative sample of US women who have been prospectively followed since 1971. Hysterectomy status was obtained by self-report and from hospital records. Although these two measures of hysterectomy were highly related, more women reported hysterectomy than could be confirmed by hospital records. The two measures showed similar associations between several obstetric and demographic characteristics and hysterectomy status, suggesting that the use of self-reported hysterectomy data does not bias analyses of potentially associated factors.     

Regional pattern of hysterectomy among women in India: Evidence from a recent large scale survey

ABSTRACT

Hysterectomy is one of the major public health issues today. In India, women’s attitudes toward menstruation may be a significant driver in seeking hysterectomy. Therefore, we attempted to study the prevalence, associated factors and reasons for hysterectomy among 540,671 ever-married women aged 15–49 years, using data from the National Family Health Survey (NFHS-4) conducted during 2015–16 in India. Univariate, bivariate and multivariate analyses were conducted. These analyses revealed that the prevalence of hysterectomy was 4.1%. The prevalence was highest in the southern region and lowest in the north-eastern regions of India. Results of multivariate models indicated that high parity (odds ratio [OR] 2.84; 95% confidence interval [CI] 2.52–3.19), high body mass index (OR-1.43; 95% CI 1.35–1.51), older age, early age at first cohabitation, and illiteracy were positively associated with hysterectomy. Excessive menstrual bleeding was the leading reason for hysterectomy in this sample. Hysterectomy has exhibited an upward trend over the years. This may exert adverse effects on the physical, socio-psychological and reproductive health of women. Therefore, it is essential to promote high-quality prevention and treatment choices for women, rather than permanent but potentially inappropriate solutions such as hysterectomy.     

Endometrial resection in the treatment of persistent metrorrhagia

STUDY OBJECTIVE: To evaluate the efficacy of hysteroscopic endometrial resection such us a surgical alternative to hysterectomy in treating abnormal uterine bleeding unresponsive to treatment with progestogens. METHODES: A retrospective analysis was carried out on 54 patients who underwent endometrial ablation for abnormal uterine bleeding unresponsive to conservative medical management between January 1, 1991, and December 31, 1998. The average patient was 43 years (Range: 36-57 years) and was followed for a mean of 37 months (range 12-80 months). RESULTS: 83.3% of women were satisfied during the study period. The overall amenorrhea rate was 29.62%. Only 16.66% of subjects reported no improvement. Histologic analysis of the endomyometrial specimens revelated hyperplasia in 48.1% of cases, atrophy in 3.7% of cases and adenomyosis in 44.6% of cases. 8 women (14.8%) needed secondary hysterectomy for continued symptoms during a mean follow up of 10 months. Adenomyosis was present in 4 specimens (50%), myomas in 3 specimens (37.5%), and the association in 1 specimen (12.5%). CONCLUSION: Endometrial ablation is a safe and effective hysteroscopic procedure for dysfunctional uterine bleeding, its prognosis depends of several factors, that shows the importance of patients selection.     

急症子宫切除在产科大出血中的应用

目的 :分析产科子宫切除发生率 ,手术原因及其临床价值。方法 :对 2 6例急症子宫切除孕产妇的资料进行回顾性分析。结果 :2 6例产科子宫切除术手术原因依次为胎盘因素 (76 .9% )、子宫破裂 (11.5 % )、子宫收缩乏力 (7.6 % )、剖宫产切口缝合不良 (3.6 % )。结论 :胎盘因素是近年来产科急症子宫切除的主要手术指征 ,产科急症子宫切除术是一项抢救急危重出血孕产妇生命的重要措施     

Correlates of hysterectomy among African-American women

Hysterectomy is the second most common surgery performed on US women. Baseline data from a large study of African-American women were used to examine correlates of premenopausal hysterectomy. Analyses were conducted on participants aged 30-49 years; 5,163 had had a hysterectomy and 29,787 were still menstruating. Multiple logistic regression was used to compute prevalence odds ratios for the association of hysterectomy with various factors. Hysterectomy was associated with region of residence: Odds ratios for living in the South, Midwest, and West relative to the Northeast were 2.63 (95% confidence interval (CI): 2.38, 2.91), 2.02 (95% CI: 1.81, 2.25), and 1.89 (95% CI: 1.68, 2.12), respectively. Hysterectomy was inversely associated with years of education and age at first birth: Odds ratios were 1.96 (95% CI: 1.74, 2.21) for < or =12 years of education relative to >16 years and 4.33 (95% CI: 3.60, 5.22) for first birth before age 20 relative to age 30 or older. Differences in the prevalence of major indications for hysterectomy did not explain the associations. This study indicates that the correlates of hysterectomy among African-American women are similar to those for White US women. The associations with geographic region and educational attainment suggest that there may be modifiable factors which could lead to reduced hysterectomy rates.     

子宫动脉栓塞和子宫切除术对卵巢功能的影响

目的探讨子宫动脉栓塞和子宫切除2种术式对子宫肌瘤患者卵巢功能的影响。方法78例子宫肌瘤患者随机分为子宫动脉栓塞术组(栓塞组)和子宫切除术组(切除组),术前、术后3个月、6个月、1年、2年用化学发光法测定患者血中生殖内分泌激素(FSH、LH、E2)水平,监测卵巢排卵功能,比较每组之间内分泌激素(FSH、LH、E2)水平的变化。结果术前栓塞组FSH、LH、E2水平与切除组比较,差异无统计学意义(P>0.05);切除组术后FSH、LH水平均较术前增高(P<0.01),E2水平较术前降低(P<0.001);栓塞组术后FSH、LH及E2水平与术前比较,无明显变化(P>0.05)。结论子宫切除术对卵巢功能影响明显,子宫动脉栓塞对卵巢功能无明显影响。     

268例子宫肌瘤临床诊疗分析

目的探讨子宫肌瘤患者临床特点、肌瘤生物学特征与手术方式的关系,为子宫肌瘤的个性化诊治提供参考。方法选择江苏盛泽医院2009年1月至2013年11月收治的子宫肌瘤行手术治疗的268例患者临床资料,对子宫肌瘤患者临床特点、肌瘤生长方式、手术方式的选择进行回顾性分析。结果268例子宫肌瘤术后标本直径0.8~19 cm,单发肌瘤107例(39.93%),多发肌瘤161例(60.07%);肌壁间肌瘤210例(78.36%),浆膜下与黏膜下肌瘤53例(19.78%),子宫颈肌瘤5例(1.87%)。术后病理结果有58例肌瘤发生部分变性,变性类型包括富于细胞型子宫肌瘤、子宫肌瘤伴红色变性、玻璃样变性、囊性变、黏液样变、脂肪变、钙化。72例患者行阴式手术治疗,其中21例子宫肌瘤切除术,31例子宫全切除术,20例子宫次全切除术;196例行经腹手术治疗,其中79例经腹子宫肌瘤切除术,87例全子宫切除术(同时行双侧附件切除21例),30例次全子宫切除术。结论肌瘤切除术适合于年轻、尚未生育需保留生育功能、患者要求保留子宫者;如患者无生育要求、肌瘤较大或较多,或疑有恶变者应行子宫切除术;选择一种最适合患者的术式是确保手术成功的关键。     

Management of abnormal uterine bleeding by northern, rural and isolated primary care physicians: PART I – How are we doing?

Background  

Canadian hysterectomy rates have declined in recent years. However, hysterectomy rates for discretionary indications, principally abnormal uterine bleeding (AUB), remain high in some regions. In northern Ontario, hysterectomy rates for women aged 34–45 are almost triple the rates in southern, urban areas. Primary care physicians (family doctors) usually manage AUB initially in these northern areas where a severe shortage of gynecologists exists.     

Hysterectomy fractions in New South Wales, 1971–2006

Hysterectomy fractions by age group for particular periods are of interest for: estimating proper population denominators for calculation of disease and procedure rates affecting the cervix and uterus; estimating the target population for Pap test programs, and response rates; and as a way of displaying the cumulative consequences of hysterectomies in a population. Hysterectomy fractions for populations can be determined by direct inquiry via a representative sample survey, or, as in this study, from prior hysterectomy rates of the cohorts of women which compose each age bracket. Hysterectomy data 1979–93 were obtained from the hospital In-patients Statistics Collection (ISC) which covers both public and private hospitals in NSW. Annual population denominators of women were obtained from Census data. Data were modelled by Poisson regression, using five-year age group (15-≥85 years), annual period, and five-year birth cohort (APC model). Forward- and back-projection of the period effects were undertaken. The resultant NSW hysterectomy fractions by age and period are consistent with fractions obtained from modelled hysterectomy rates for Western Australia (1980–84), and fractions from national representative sample surveys (1989/90 and 1995) for younger women, but not for women aged >70 years in 1995, which revealed higher hysterectomy fractions than modelled hysterectomy data would suggest.
Hysterectomy fractions for NSW women by five-year age group for quinquennia centred on 1971 to 2006 are provided.