Total versus subtotal hysterectomy for benign gynaecological conditions

 

Abstract

Background

Hysterectomy using an abdominal approach removes either the uterus alone (subtotal hysterectomy) or both the uterus and the cervix (total hysterectomy). The latter is more common but outcomes have not been systematically compared.

Objectives

To assess and compare outcomes with subtotal hysterectomy versus total abdominal hysterectomy for benign gynaecological conditions.

Search methods

We searched the Cochrane Menstrual Disorders and Subfertility Group's specialised register of controlled trials (December 2005), Central (December 2005), Medline (1966 to December 2005), EmBase (1980 to December 2005), Biological Abstracts (1980 to December 2005), the National Research Register and relevant citation lists.

Selection criteria

Only randomised controlled trials of women undergoing either total or subtotal hysterectomy for benign gynaecological conditions were included.

Data collection and analysis

Three trials that included 733 women were included. Independent selection of trials and data extraction were undertaken by 2 reviewers and results compared.

Main results

There was no evidence of a difference in the rates of incontinence, constipation or measures of sexual function. In one unblinded trial, a significantly greater proportion of women indicated that they had frequent episodes of urinary incontinence after subtotal hysterectomy when compared with total hysterectomy (OR=2.1, 1.02 to 4.3), but these results were not confirmed by the other two trials that measured both stress and urge incontinence and urinary frequency. . Length of surgery and amount of blood lost during surgery were significantly reduced during subtotal hysterectomy when compared with total hysterectomy, but there was no evidence of a difference in the odds of transfusion. Febrile morbidity was less likely (OR=0.43, 0.25 to 0.75) and ongoing cyclical vaginal bleeding one year after surgery was more likely (OR=11.3, 4.1 to 31.2) after subtotal when compared with total hysterectomy. There was no evidence of a difference in the rates of other complications, recovery from surgery or readmission rates.

Authors' conclusions

This review has not confirmed the perception that subtotal hysterectomy offers improved outcomes for sexual, urinary or bowel function when compared with total abdominal hysterectomy. Surgery is shorter and intraoperative blood loss and fever are reduced but women are more likely to experience ongoing cyclical bleeding up to a year after surgery with subtotal hysterectomy compared to total hysterectomy.

 

Plain language summary

Total versus subtotal hysterectomy for benign gynaecological conditions

When abdominal hysterectomy is required for non cancerous conditions, either the uterus alone (subtotal hysterectomy) or the uterus and the cervix (total hysterectomy) are removed. Some people have suggested that not removing the cervix (subtotal hysterectomy) would reduce the chance of sexual difficulties and/or problems with passing urine or solids. This review has found no evidence of a difference between these 2 types of surgery for these outcomes. Surgery is faster with subtotal hysterectomy and there is less blood loss and fever during or just after surgery but women are more likely to have long term ongoing menstrual bleeding, when compared with total hysterectomy.

 

摘要

背景

全與次全子宮切除術對於良性婦科疾病之比較

腹部子宮切除術可僅移除子宮 (次全子宮切除術) 或是移除子宮及子宮頸兩者 (全子宮切除術) 。後者較為常見，但其結果不曾進行系統性之比較。

目標

針對良性婦科疾病，評估並比較次全子宮切除術與全子宮切除術。

搜尋策略

我們搜尋 Cochrane Menstrual Disorders以及Subfertility Group's specialised register of controlled trials (2005年12月) 、 Central (2005年12月) 、 Medline (1966年2005年12月) 、 EmBase (1980年2005年12月) 、 Biological Abstracts (1980年2005年12月) 、National Research Register及相關的參考文獻清單。

選擇標準

僅收錄有關因為良性婦科疾病而進行全或次全子宮切除術之婦女的隨機對照試驗。

資料收集與分析

共收錄包括733名參與者之3項試驗。由2位回顧作者獨立進行試驗篩選及數據摘錄並比較結果。

主要結論

並無證據顯示失禁率、便祕率、或性功能標準方面之差異。在其中1項遮盲試驗中，相較於全子宮切除術，顯著較高比例之婦女指出其在進行次全子宮切除術後常有尿失禁之情形 (OR = 2.1, 1.02 to 4.3) ，但此等結果並無法由其他2項測量應力性及急迫性尿失禁兩者以及排尿頻率之試驗確認。在與全子宮切除術比較時，次全子宮切除術之手術時間長度以及手術失血量皆顯著減少，但並無證據顯示輸血機率之差異。相對於全子宮切除術，次全子宮切除術後較少發生術後發燒 (OR = 0.43, 0.25 to 0.75) ，但在手術後1年內較常發生持續週期性之陰道出血 (OR = 11.3, 4.1 to 31.2) 。並無證據顯示其他併發症之發生率、手術復原情形、或再入院率的差異。

作者結論

本回顧並無法確認，相較於全子宮切除術，次全子宮切除術可提供性、泌尿、或腸道功能較佳之結果。相較於全子宮切除術，次全子宮切除術之手術費時較短，且其具有較低之手術失血及發燒情形，但直至手術後1年，婦女仍較可能發生持續週期性之陰道出血。

翻譯人

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

當因為非癌症疾病而需要進行腹部子宮切除時，其可僅移除子宮 (次全子宮切除術) 或是移除子宮及子宮頸 (全子宮切除術) 。部分研究者建議，不移除子宮頸 (次全子宮切除術) 可能會降低發生性功能障礙以及／或是排尿或排便困難的機率。本回顧並未發現證據說明此2種類型之手術在此等結果方面具有差異。相較於全子宮切除術，次全子宮切除術之手術進行較快，且其在手術中及手術剛結束時具有較低之失血及發燒情形，但是婦女較可能發生長期之月經出血。