| Research Background:Ovarian cancer(Ovarian Cancer,OC)is located in the female reproductive system malignancy mortality in the first place,the current pathogenesis has been to explore the early clinical manifestations of non-specific,lack of effective and accurate screening means,most patients have reached clinical late treatment,5-year survival rate is difficult to reach 40%.In recent years,a large number of studies have shown that: ovarian cancer may originate in the fallopian tube.The theory shocked long-term ovarian cancer originated in the ovarian theory of its own supporters,the clinical work of the surgical decision-making had a significant impact.For gynecological benign disease without fertility requirements of patients with hysterectomy whether the addition of bilateral tubal resection to reduce postoperative fallopian tube disease(prolapse,water,empyema,malignancy,etc.),pelvic mass,encapsulated effusion Incidence,and even the prevention of ovarian cancer.But at the same time plus bilateral tubal resection will increase the risk of surgery,intraoperative and postoperative complications,the most important is whether intraoperative ovarian blood supply damage caused by postoperative changes in ovarian function and accelerated without menopause Women 's menopause early arrival pace.In this study,we studied the effects of Hysterectomy with bilateral salpingectomy(HWBS)on Hysterectomy alone(HA)at the same time as hysterectomy,and the postoperative ovariectomy Function,postoperative pelvic mass incidence,ovarian cancer and other aspects of the situation,to explore the gynecological benign disease at the same time the feasibility of bilateral salpingectomy and clinical significance.Objective:To evaluate the safety and clinical significance of hysterectomy underwent bilateral salpingectomy with simple hysterectomy.Methods:Retrieve China Knowledge Network by Computer Chinese Journal of Biotechnology,Chinese Academy of Sciences,Beijing 100083,China)Objective: To study the literatures of Pubmed,Web of science,Medline and OVID.All clinical data related to benign gynecological diseases and simple uterine hysterectomy underwent hysterectomy and bilateral salpingectomy and simple hysterectomy.The Browse the title and abstracts of the literature,carefully read the full text of the literature that may meet the inclusion criteria,remove the quality of the unqualified or do not meet the inclusion of the literature,will meet the inclusion of all the documents compiled after the two groups.The changes of ovarian function(monitoring of FSH and E2),postoperative pelvic mass and ovarian cancer were grouped by operation safety(intraoperative blood loss,hospitalization time,postoperative gastrointestinal function recovery time)Experimental group:hysterectomy at the same time preventive prophylactic bilateral tubal resection;control group: simple hysterectomy.The clinical data of the experimental group and the control group were analyzed by statistical method to evaluate the intraoperative bleeding,hospitalization time,gastrointestinal function recovery,postoperative ovarian function,postoperative pelvic mass and ovarian cancer.Statistical methods Meta-analysis was performed on the included literature using R software(R 3.3.2 software)and Meta package.Result:1.Hysterectomy at the same time prevention of bilateral salpingectomy and simple hysterectomy in hospitalization time,were included in 11 articles,13772 cases were selected.HW23 group of 4431 cases,HA group 9341 cases.The homogeneity of each group was better(p> 0.05),I2 = 0%,P = 0.98.Heterogeneity is almost negligible,statistical analysis using fixed effect model.The 95% confidence interval between the HWBS group and the HA group was [0.23;0.08].2.Hysterectomy at the same time bilateral tubal resection and simple hysterectomy in the two groups of bleeding compared to a total of 10 articles included,including 1540 cases.There were 804 cases of HWBS group and 736 cases in HA group.The homogeneity of the clinical data was good(p> 0.05),I2 = 0%,P =0.83.Selection of fixed effect model.The 95% confidence interval between HWBS group and HA group was: [0.71;2.27].3.Hysterectomy with bilateral salpingectomy and simple hysterectomy after two groups of gastrointestinal function recovery,a total of eight articles included,including 1412 cases.HWS group 740 cases,HA group 672 cases.The homogeneity of the clinical data was good(p> 0.05),I2= 0%,P = 0.46.Selection of fixed effect model.According to the analysis of meta-analysis,the 95% confidence interval of HWBS group and HA group was: [0.32;0.86].4.There were significant changes in ovarian function between the two groups after simple hysterectomy and hysterectomy.Ovarian Function Assessment This study was performed by monitoring the levels of follicle stimulating hormone(FSH)and estrogen(E2)in the blood of both groups before and 3 months postoperatively.A total of 8 articles were included,including 1152 cases.HWBS group of 610 cases,54 cases of HA group.Random effects model.The 95% confidence interval of 95%confidence interval of preoperative E2 was: [-0.24;0.00],and the confidence interval of 95% confidence interval of preoperative monitoring of FSH in HWBS group was: [-0.09;0.15] The 95% confidence interval of the 95% confidence interval of the month was: [-0.12;0.20],95% confidence interval of E2 in the 3 months postoperatively: [-0.20;0.04],FSH and LH 95% There is almost no change in the letter interval.5.There was a significant difference between the two groups in the treatment of pelvic mass in both groups after bilateral hysterectomy and hysterectomy.A total of7 articles were included in 1141 cases.591 cases of HWBS group,550 cases of HA group.The heterogeneity of the clinical data was poor(p> 0.05),I2= 11%,P = 0.51,and the fixed effect model was used for statistical analysis.The OR value and 95%confidence interval of pelvic mass in HWBS group and HA group were 0.31 [0.20;0.47].6.The incidence of ovarian cancer was compared between two groups after bilateral hysterectomy and hysterectomy.A total of 6 articles were included in5659840 cases.HW2 group 3831 cases,HA group 5656009 cases.The heterogeneity between the clinical data was not found(p> 0.05),I2 = 0%,P = 0.51,and the fixed effect model was used for statistical analysis.The OR value of the ovarian cancer and the 95% confidence interval in the HWBS group and the HA group were 0.45 [0.32;0.64].In conclusion:This study showed that: HWBS group compared with HA group,the two groups of hospitalization time,the former hospital stay shorter,statistically significant.Intraoperative blood loss,postoperative gastrointestinal function recovery time,no statistically significant.At the same time,bilateral tubal resection did not accelerate the process of ovarian failure after surgery,the difference was not statistically significant.At the same time,the incidence of postoperative pelvic mass and the probability of ovarian cancer were lower in HWBS group than those in HA group,the difference was statistically significant.Due to the limited follow-up time,the current postoperative ovarian function of the follow-up time is shorter,whether bilateral oviduct surgery to increase the process of long-term ovarian recession is still inconclusive.Probability of postoperative ovarian cancer happen in less number of research articles,the lack of a large number of clinical case studies,a large number of cases to further explore the implementation of hysterectomy plus bilateral tubal resection does reduce the risk of postoperative ovarian cancer. |
PDF Full Text Request