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Sabbour SM 《The Journal of the Egyptian Public Health Association》2001,76(1-2):71-87
Hysterectomy is one of the most frequently performed major surgical procedures for women. Study the epidemiological correlates of hysterectomy and identify the different indications that lead to the operation as well as determine its frequency. SUBJECTS AND METHODS: A retrospective study was performed which included 231 women who had undergone hysterectomy during 1995-1996. Data about the various characteristics of women, indication, and type of surgery were retrieved from the medical fles of women in Ain Shams Maternity Hospital. RESULTS: The hospital incidence rate of hysterectomy during 1995-1996 was 9.8/1000 admission, while it rose to 13.8/1000 in the year 2000 (recent data from hospital statistics unit) Epidemiological data showed that the mean age of women was 45.4+/-8.9, the highest frequency of hysterectomy was in the age group 45-54 years (41.2%). Hysterectomy in those aged less than 35 years was 7.3%. Previous abortion accounted for 48.5% early age at menarche (< or =12) was 13%, multiparity (> or =5) was 54.4%. Among women aged less than 35 years, uterine leiomyoma was the commonest indication (29.4%), while dysfunctional uterine bleeding was the commonest indication among those aged 35-<45, and 45-<55 and accounted for 40.6% and 60% respectively. Those aged > or =55 years, uterine prolapse was the commonest indication (53.6%). Malignant neoplasm covered less than 5% of all hysterectomies. Among nullipara, uterine leiomyoma was the most frequent indication (66.7%), while among parous women, dysfunctional uterine bleeding was the most frequent (56%). The most common obstetric indication leading to hysterectomy was uncontrolled postpartum hemorrhage and ruptured uterus (57.2%) of all obstetric causes. The abdominal route was the commonest approach for hysterectomy (54.1%), followed by the vaginal (35.9%). CONCLUSION AND RECOMMENDATIONS: Hysterectomy rate in Ain Shams Maternity hospital showed a significant increase by the year 2000 than during the period of the study. Further studies are needed to identify the reasons for such increase and to reduce unnecessary operations. The present study draws the attention of the importance of prenatal care for early detection of high risk women, and prevent complications of bleeding specially in women under 35 years who may not have completed their families and who may prefer other alternatives to surgery. 相似文献
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Tietz C 《Minnesota medicine》2001,84(4):47-49
In the United States, approximately 600,000 patients per year undergo surgical removal of the uterus at considerable cost to payers, patients, and society at large. Currently, most hysterectomies are performed via abdominal or vaginal surgery, but laparoscopic-assisted procedures are becoming more popular. Many studies have shown that laparoscopic surgery is a safe, effective, and less-intrusive alternative to open surgery. Laparoscopic surgery can be far less costly and painful, and it results in shorter hospital stays and recovery times. This paper compares laparoscopic supracervical hysterectomy with laparoscopic-assisted and standard hysterectomy and reviews 83 laparoscopic supracervical hysterectomies performed at a rural Minnesota hospital. Techniques, equipment, patient mix, indications, and complications are discussed. Most patients encountered few complications and were discharged from the hospital within 48 hours. The report demonstrates that laparoscopic supracervical hysterectomy is a beneficial alternative to standard and laparoscopic-assisted hysterectomy that can be performed in local hospitals. 相似文献
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《Evidence-based Healthcare》2004,8(4):232-234
QuestionIs the risk of major complications greater following laparoscopic hysterectomy compared with abdominal and vaginal hysterectomy for non-malignant conditions?Study designTwo parallel, multi-centre randomised trials.Main resultsMore major complications were experienced with laparoscopic hysterectomy compared with abdominal hysterectomy (11.1% vs 6.2%; mean difference 4.9%, 95% CI 0.9% to 9.1%, number needed to harm 20). There was no significant difference in complication rates between laparoscopic and vaginal hysterectomy groups (complication rate 9.5% for both groups).Pain scores were higher following abdominal hysterectomy compared with laparoscopic hysterectomy (mean difference 0.4, 95% CI 0.09 to 0.7). There was no detectable difference in the vaginal trial. Quality of life at 12 months improved with all interventions.Authors’ conclusionsMajor complications were more common following laparoscopic hysterectomy compared with abdominal hysterectomy. The vaginal trial was inconclusive. 相似文献
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目的:比较腹式子宫切除术(TAH)、阴式子宫切除术(TVH)与腹腔镜辅助下阴式子宫切除术(LAVH)的不同手术适应证及效果,探讨3种子宫切除术式的最佳选择。方法:回顾性分析安徽省立友谊医院2005年9月~2007年12月及也门哈德拉毛大学附属木卡拉医院2008年1月~12月接受上述3种不同术式子宫切除术病例62例,比较3种手术在手术时间、术中出血量、术后肛门排气时间、术后下床活动时间、术后住院日、术中术后并发症及3者的手术适应证(尤其是子宫大小、盆腔粘连等)。结果:3组平均手术时间、术中平均出血量无统计学差异(P>0.05);TVH组及LAVH组在术后肛门排气时间、术后下床活动时间、术后住院天数、术后疼痛及体温方面与TAH组比较差异有统计学意义(P<0.05)。结论:TVH与LAVH为创伤小、恢复快的微创手术,但TVH适应于子宫小、无粘连并伴下垂者,而LAVH扩大了TVH的适应证,拓宽了阴式手术的选择范围。 相似文献
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Merrill RM 《Annals of epidemiology》2001,11(2):127-135
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. 相似文献
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《Evidence-based Healthcare》2004,8(4):197-199
QuestionWhat is the cost effectiveness of laparoscopic hysterectomy compared with conventional (vaginal or abdominal) hysterectomy?Study designTwo parallel multicentre randomised controlled trials.Main results Vaginal hysterectomy:Laparoscopic hysterectomy was significantly more expensive than vaginal hysterectomy, however there were no differences in quality adjusted life years (QALYs; see Table 1).Abdominal hysterectomy:There were no significant differences between abdominal and laparoscopic hysterectomy for cost or QALYs. For each additional QALY, laparoscopic hysterectomy was estimated to cost £267,333 more than vaginal hysterectomy, and £26,571 more than abdominal hysterectomy.
Table 1 Relative cost and effectiveness of laparoscopic versus conventional hysterectomy techniques (£ sterling at 1999/2000 rates). | |||
Comparison | Mean difference in cost (95% CI) | Mean difference in QALYs (95% CI) | ICER |
Laparoscopic vs vaginal | £401 (271 to 542) | 0.0015(–0.0015 to 0.018) | £267,333 |
Laparoscopic vs abdominal | £186 (–26 to +375) | 0.007(–0.008 to 0.023) | £26,571 |