子宫切除术后阴道断端裂开的预后因素:巢式病例对照研究  

Prognostic Factors of Vaginal Cuff Dehiscence After Hysterectomy:a Nested Case-control Study

作　　者：王家鹤 潘晓萌 孔繁斗[2] 李冰[3] 董晓红[4] 韩璐 Wang Jiahe;Pan Xiaomeng;Kong Fandou(Department of Gynecology, Dalian Obstetrics and Gynecology Hospital, Dalian 116033, China;不详)

机构地区：[1]大连医科大学附属大连市妇产医院暨大连市妇幼保健院妇科,大连116033 [2]大连医科大学附属第一医院妇科,大连116001 [3]大连大学附属中山医院妇科,大连116001 [4]大连市友谊医院妇科,大连116001

出　　处：《中国微创外科杂志》2020年第8期678-681,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨影响子宫切除术后发生阴道断端裂开的预后因素及诱发因素。方法采用巢式病例对照研究方法,2015年1月~2018年9月大连市妇幼保健院等4所医院收治的21例子宫切除术后阴道断端裂开为病例组,通过病例组的手术日期,检索同一术者在此时点最为接近的全子宫切除术或广泛性全子宫切除术;按照1∶4匹配同期对照组84例。分析年龄、BMI、绝经、恶性肿瘤手术史、原发疾病性质、手术相关情况、术后发病时间及可能的诱因等对阴道断端裂开的影响。结果单因素分析显示,病例组BMI≥24比例低(OR=0.342,P=0.029),恶性肿瘤比例高(OR=3.742,P=0.003),手术时间长(P=0.027),手术途径为腹腔镜的比例高(OR=8.000,P=0.022)。多因素分析显示BMI≥24(OR=0.261,95%CI:0.088~0.777,P=0.016),手术时间长(OR=1.016,95%CI:1.003~1.029,P=0.013)及手术途径为腹腔镜(OR=9.598,95%CI:1.161~79.363,P=0.036)是影响阴道断端裂开的独立预后因素。病例组术后中位发病时间为3个月。发病诱因包括性生活4例,放疗3例,便秘3例,阴式超声检查后2例,膀胱阴道瘘1例,阴道断端感染1例,慢性咳嗽1例。结论手术途径、BMI、手术时间是影响子宫切除术后阴道断端裂开的预后因素;性生活、放疗、慢性咳嗽、阴式超声检查、阴道断端感染及便秘是其直接诱发因素。Objective To explore the prognostic factors and the predisposing factors of vaginal cuff dehiscence after hysterectomy.Methods A nested case-control study was used to retrospectively analyze 21 cases of vaginal cuff dehiscence after hysterectomy in 4 hospitals from January 2015 to September 2018(case group).According to the operation date,the total hysterectomy or radical hysterectomy at the closest time point of the same operator were retrieved,with 84 cases of the same period matched as control group according to 1∶4.The influence of age,BMI,menopause,previous operation history of malignancy,nature of primary disease,operation related situation,postoperative onset time and possible inducement on vaginal cuff dehiscence were explored.Results Univariate analysis showed that the case group had low proportion of BMI≥24(OR=0.342,P=0.029),high proportion of malignancy(OR=3.742,P=0.003),long operation time(P=0.027),and high proportion of laparoscopic surgery(OR=8.000,P=0.022).Multivariate analysis showed that BMI≥24(OR=0.261,95%CI:0.088-0.777,P=0.016),long operation time(OR=1.016,95%CI:1.003-1.029,P=0.013)and laparoscopic approach(OR=9.598,95%CI:1.161-79.363,P=0.036)were independent prognostic factors of vaginal cuff dehiscence.The median postoperative time of the study group was 3 months.The predisposing factors included:4 cases of coitus,3 cases of radiotherapy,3 cases of constipation,2 cases of transvaginal ultrasound,1 case of vesicovaginal fistula,1 case of vaginal stump infection and 1 case of chronic cough.Conclusions Surgical approach,BMI and operation time are prognostic factors for vaginal cuff dehiscence.Coitus,radiotherapy,chronic cough,vaginal ultrasonography,vaginal infection and constipation are direct triggers.

关 键 词：子宫切除术 阴道断端裂开 巢式病例对照研究 预后因素 

分 类 号：R73[医药卫生—肿瘤]