阴式全子宫切除术临床结局的危险因素分析

目的 探讨阴式全子宫切除术不良临床结局的危险因素,为临床手术决策提供依据。方法 本研究为单中心回顾性队列研究。收集行阴式子宫切除术(VH)的子宫肌瘤患者102例。记录年龄、腹部手术史、剖腹产史、肥胖、合并内科疾病、子宫大小、瘤体位置、子宫粘连等。将所有患者分为两组:良性临床结局组和不良临床结局组,以手术失败和术后并发症等复合指标定义不良临床结局,采用logistics回归分析阴式子宫切除术不良临床结局的危险因素。结果 术后有18例(17.6%)患者出现了阳性事件。与良性临床结局组比较,不良临床结局组腹部手术史比例、子宫大于12孕周比例,瘤体位于子宫下段比例以及子宫粘连比例显著增高(P＜0.05)。logistics回归分析显示:子宫大小(OR=6.407,P=0.008)、瘤体位置(OR=7.186,P=0.020)、子宫粘连(OR=11.672,P=0.011)是发生不良临床结局的独立危险因素。结论 子宫体积大于12孕周、瘤体位于子宫下段以及子宫粘连显著增加了TVH的手术风险,临床上应该充分考虑这些情况,以确保手术安全。

Analysis of risk factors for surgical outcome invaginal hysterectomy

Objective The aim of the study was to analysis of risk factors for surgical outcome of vaginal hysterectomy and to provide operative strategy for clinical practice.Methods This was a retrospective cohort study based in a single medical center. 102 patients who had an indication for hysterectomy for uterine fibroids were selected. Patient demographics,previous abdominal surgery,previous cesarean section,obesity,combined with internal disease,uterus size,location of uterine fibroids,and adherence of uterus were recorded.All patients were divided into benign surgicaloutcome group and poor-surgical outcomegroup. Poorsurgical outcome was defined as failure operation and complications. Logistic regression analysis was used to identify significant risk factors of surgical outcome.Results 18 (17.6%) had poor surgical outcome. The previous abdominal surgery,uterus size≥12gestational weeks ,uterine fibroids locate lower uterine segment,and adherence of uteruswere significantly higher in patients with poorsurgical outcome compared with those with satisfactory surgical outcome(P＜0.05). Logistic regression analysis showed that uterus size(OR=6.407,P=0.008),location of uterine fibroids(OR=7.186,P=0.020),and adherence of uterus (OR=11.672,P=0.011)were independent risk factor for poorsurgical outcome. Conclusion Uterus size≥12gestational weeks,uterine fibroids locate lower uterine segment ,and adherence of uterus remarkably increase operative risk. These factors should sufficiently consider in clinical practice to security operation.