Prognostic Factors Of Vaginal Cuff Dehiscence After Hysterectomy:A Nested Case-control Study

Objective:Through the nested case-control study,retrospective analysis of the patient's case data,to explore the postoperative incidence,prognostic factors and the predisposing factors of vaginal cuff dehiscence after hysterectomy;Methods:Using the nested case-control study method,a retrospective analysis was made of 21 cases of vaginal cuff dehiscence after hysterectomy in the cohort of patients with whole uterus and extensive whole uterus admitted to 4 hospitals from January2015 to September 2018.Through the operation date of the case group,the closest total hysterectomy at the same time point in the same hospital was retrieved according to1:4,84 cases in the control group were matched.Spss22.0 software was used for data analysis.The measurement data of normal distribution is expressed by x±s,and the comparison between groups is expressed by independent sample t test;the measurement data of skew distribution is expressed by median(m)and quartile interval(IQR),and the comparison between groups is expressed by Mann Whitney U test.The number and percentage of cases(%)were used as the counting data,and?~2test was used for comparison between groups,P<0.05 was statistically significant.The single factor analysis with statistically significant differences was further included in the multivariate logistic regression model(regression method)to analyze the independent factors influencing the prognosis of vaginal rupture.There was significant difference between the two sides(P<0.05).To explore the influence of age,BMI,menopause,previ-ous operation history of malignancy,nature of primary disease,operation relate-d situation,postoperative onset time and possible inducement on vaginal cuff dehiscence;Results:The average incidence rate of vaginal cuff dehiscence after hysterectomy was0.30%(21/7103),0.46%(20/4320)after laparoscopy,0.04%(1/2309)after abdominal surgery,and 0%(0/474)after vaginal surgery.The incidence rate of vaginal cuff dehiscence after laparoscopic surgery was higher than that of abdominal type(2=8.392,P<0.05).The development time of vaginal cuff dehiscence was 10 days to 34 months,and the median time was 3 months.Univariate analysis showed that the proportion of BMI?24 was low(OR=0.342,P=0.029),the proportion of malignancy was higher(P=0.003),and the operation time was longer than that of the control group(P=0.027),there was no significant difference in age,menopause rate,preoperative complications,bleeding volume and hospitalization time(P>0.05);multivariate analysis showed that BMI?24(OR=0.261,95%CI 0.088-0.777,P=0.016)and operation time was more than101.4min(OR=1.016,95%CI 1.003-1.029,P=0.013)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;Conclusion:the incidence rate of vaginal cuff dehiscence after different surgical approaches is different,the incidence rate of vaginal cuff dehiscence after laparoscopic surgery is than that of transabdominal and transvaginal surgery.The median time of onset was 3 months after operation.BMI,malignancy and operation time are prognostic factors affecting vaginal cuff dehiscence.coitus,radiotherapy and chemotherapy,constipation and chronic cough,vaginal ultrasonography,vaginal infection are direct triggers.