Hysterectomy versus hysterectomy plus oophorectomy for premenopausal women

 

Abstract

Background

Prophylactic oophorectomy alongside hysterectomy in premenopausal women is common. The decision to remove or conserve the ovaries is often based on the perceived risk for ovarian cancer and the need for other additional gynaecological surgical interventions. The benefits or harms of prophylactic bilateral oophorectomy at the time of hysterectomy in premenopausal women are unknown.

Objectives

To determine whether premenopausal women with hysterectomy without oophorectomy for benign gynaecological conditions versus hysterectomy plus bilateral oophorectomy would have a higher mortality rate and future gynaecological surgical interventions.

Search methods

We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register (December 2005 to October 2007) and the following electronic databases: CENTRAL (The Cochrane Library 2007, Issue 4), MEDLINE (January 1966 to October 2007), EMBASE (January 1985 to October 2007), LILACS (January 1982 to October 2007), Biological Abstracts (January 1968 to October 2007), NHS Economic Evaluation Database (inception to October 2007), Health Technology Assessment Database (inception to October 2007), and the Meta RCTs (inception to October 2007). Reference lists of relevant articles were also searched.

Selection criteria

Randomised controlled and controlled trials of hysterectomy (using any surgical approach) without oophorectomy versus hysterectomy (using any surgical approach) with bilateral oophorectomy in premenopausal women with benign gynaecological conditions.

Data collection and analysis

Three review authors independently assessed trials for inclusion, determined study quality and extracted data. Study authors were contacted where information was unclear.

Main results

Of the 119 studies identified, only one controlled trial was included. Therefore, a quantitative meta-analysis was not feasible. The results of this study (with two publications) including 362 women were summarised in a narrative format. No randomised controlled trials were found.

Neither publication reported on the primary outcomes stated in this review. The trial showed evidence of very low quality of a positive effect on psychological well-being for both groups at one year follow up. No significant differences were found between the groups of women studied regarding any aspect of their sexuality.

Authors' conclusions

The conclusions of this review are limited by the lack of data. More research of higher methodological quality is needed.

 

Plain language summary

Hysterectomy versus hysterectomy plus oophorectomy for premenopausal women

Removing the ovaries at the time of hysterectomy could potentially improve longevity as it reduces the risk of ovarian cancer and the need for future gynaecological procedures. However, women who have had their ovaries removed have also been reported to have an increase in cardiovascular disease. Currently, there are no good quality studies of the benefits or harms of removing the ovaries at the time of hysterectomy. Until well-designed studies that compare women undergoing hysterectomy with women undergoing hysterectomy and removing ovaries are undertaken, removing the ovaries at the time of hysterectomy should be approached with caution.

 

摘要

背景

子宮切除術與子宮切除術加卵巢切除術對於停經前婦女之比較

停經前之婦女常會在進行子宮切除術時加上進行預防性之卵巢切除。移除或保留卵巢之決定常係根據其對於卵巢癌以及需要進行其他額外婦科手術之自覺風險。針對停經前之婦女，在進行子宮切除術之同時進行預防性之雙邊卵巢切除術的效益或害處仍為未知。

目標

判定針對良性婦科病況進行子宮切除術但未進行卵巢切除術之停經前婦女，相對於進行子宮切除術加上雙邊卵巢切除術者，是否具有較高之死亡率及未來之婦科手術干預。

搜尋策略

我們搜尋 Cochrane Menstrual Disorders以及Subfertility Group Trials Register (2005年12月 to 2007年10月) 以及以下電子資料庫: CENTRAL (Cochrane Library 2007, Issue 4) 、 MEDLINE (1966年1月2007年10月) 、 EMBASE (1985年1月2007年10月) 、 LILACS (1982年1月2007年10月) 、 Biological Abstracts (1968年1月2007年10月) 、 NHS Economic Evaluation 資料庫 (創刊至2007年10月) 、 Health Technology Assessment 資料庫 (創刊至2007年10月) 、the Meta RCTs (創刊至 2007年10月) 、以及所找到的研究的參考資料清單。

選擇標準

針對具有良性婦科病況之停經前婦女，比較進行子宮切除術 (使用任何手術方法) 但未進行卵巢切除術者與進行子宮切除術 (使用任何手術方法) 且亦進行雙邊卵巢切除術者的隨機對照試驗及對照試驗。

資料收集與分析

由3位回顧作者獨立評估予以收錄之試驗，判定研究品質，及擷取數據。針對未明的資訊聯絡研究作者取得。

主要結論

在所辨識出之119項研究中，僅收錄1項對照試驗。因此，無法進行量性整合分析。以敘述形式摘錄此一包括362名婦女之實驗結果 (共有2篇出版文獻) 。並未發現任何隨機對照試驗。該2篇出版文獻皆未報告本回顧所言及之首要結果。該試驗僅顯示極低品質之證據，說明其在1年追蹤期間對該兩組病患之心理健康所產生的正面效應。在所研究之婦女分組間，並未發現任何有關其性行為方面的顯著效應差異。

作者結論

本回顧之結論因為缺乏數據而受限。仍需要更多具有較高方法學品質之研究。

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

在進行子宮切除術之同時除去卵巢潛在可能使病患更為長壽，因其降低了發生卵巢癌以及未來需要進行婦科手術之風險。然而亦有報告指出，移除卵巢之婦女具有較高之心血管疾病風險。目前，並無品質良好之研究可說明在子宮切除術之同時移除卵巢的效益及害處。在針對進行子宮切除術之女性與進行子宮切除術並移除卵巢之女性進行設計良好的比較研究之前，應小心提出在進行子宮切除術之同時除去卵巢之建議。