Öz
Aim. Examine the clinical indications for hysterectomy operations performed in our clinic and put forward the histopathologic diagnosis of hysterectomy materials. Method. 223 total abdominal hysterectomy cases performed between January 2010-January 2013 were retrospectively evaluated. Age, menopausal status, operation indication, the operation data and the results of materials pathological examination were analyzed. Results. The mean age of the patients was 49.3±5.4. All cases underwent total abdominal hysterectomy. 76.2% of the patients was performed bilateral oopherectomy, 17.4% of the patients was performed unilateral oopherectomy, 6.2% of the patients was performed only hysterectomy. Between the hysterectomy indications the most common one was leiyomyom with 138 patients (61.8 %). The other indications were dysfunctional uterine bleeding with 38 patients (17%), adnexal masses with 37 patients (16.5%), pelvic organ prolapse with 10 patients (4.4%). As the result of histopathological examinations of hysterectomy materials, the most common pathologies are defined as leiomyom, adenomyosis, and ovarian/paraovarian cyst with the rates 68.1%, 37.2%, 18.8%, respectively. The most common combination was leiomyom and adenomyosis combination with the ratio of 15.2%. In addition, 19 patients (8.5%) were determined with endometrial polyps, 15 patients (6.7%) with endometrial hyperplasia, 11 patients (4.9%) with atrophic endometrium, 4 patients (1.7%) with cervical intraepithelial neoplasia, 3 patients (1.3%) with endometrial cancer. Conclusion. In our study, the most common indication of hysterectomy was uterine myoma as the literature. The most common histopathological examination result was leiomyom and adenomyosis. Adenomyosis must be kept in mind in patients who consulted with complaint of menometrorrhagia/ pelvic pain and especially having myoma. Hysterectomy is the most preferred choice in treatment of pelvic pain and also myomas causing menometrorrhagia in perimenopausal with no further desire of childbearing and postmenopausal women.
Anahtar Kelimeler
Kaynakça
- Rock JA, Jones HW III, Histerektomi, In: Te Linde’s Operatif Jinekoloji 9. Basım, Çeviri Editörü: Erol Tavmergen, İzmir Güven Kitabevi 2005; 31: 731-55. Coulter A, Bradlow J, Agass M, Martin-Bates C, Tulloch A. Outcomes of referrals to gynaecology outpatient clinics for menstrual problems: An audit of general practice records. Br J Obstet Gynaecol 1991; 98: 789-96.
- Davies A, Magos AL. Indications and alternatives to hysterectomy. Baillieres Clin Obstet Gynaecol 1997; 11: 61-75.
- Bren L. Alternatives to hysterectomy. New technologies, more options. FDA Consum. 2001; 35: 23-8.
- Marana R, Busacca M, Zupi E, Garcea N, Paparella P, Catalano GF. Laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy: A prospective, randomized, multicenter study. Am J Obstet Gynecol 1999; 180: 270-5.
- Kovac SR, Barhan S, Lister M, Tucker L, Bishop M, Das A. Guidelines for the selection of the route of hysterectomy: application in a resident clinic population. Am J Obstet Gynecol 2002; 187: 1521-7.
- Speroff T, Dawson NV, Speroff L, Haber RJ. A risk-benefit analysis of elective bilateral oophorectomy: effect of changes in compliance with estrogen therapy on outcome. Am J Obstet Gynecol 1991; 164: 165-74.
- Vessey MP, Villard-Mackintosh L, McPherson K, Coulter A, Yeates D. The epidemiology of hysterectomy: Findings in a large cohort study. British J Obstet Gynecol 1992; 99: 402-7.
- Dicker RC, Greenspan JR, Strauss LT, Cowart MR, Scally MJ, Peterson HB, DeStefano F, Rubin GL, Ory HW. Complications of abdominal and vaginal hysterectomy among women of reproductive age in the United States. The Collaborative Review of Sterilization. Am J Obstet Gynecol 1982; 144: 841-8.
- García CR, Cutler WB. Preservation of the ovary: A reevaluation. Fertil Steril 1984; 42: 510-4.
- Grundsell H, Ekman G, Gullberg B, Johnsson JE, Larsson G, Lindahl B, Möller T, Trope C. Some aspects of prophylactic oophorectomy and ovarian carcinoma. Ann Chir Gynaecol 1981; 70: 36-42.
- Cole P, Berlin J. Elective hysterectomy. Am J Ostet Gynecol 1977; 129: 177-23. Tazegül A, Acar A. Kliniğimizde Gerçekleştirilen Histerektomi Olgularının Klinik ve Demografik Özelliklerinin Değerlendirilmesi. Selçuk Tıp Dergisi 2010; 26: 19-22.
- Wilcox LS, Koonin LM, Pokras R, Strauss LT, Xia Z, Peterson HB. Hysterectomy in the United States, 1988-1990. Obstet Gynecol 1994; 83: 549-55. Maresh MJ, Metcalfe MA, McPherson K, Overton C, Hall V, Hargreaves J, Bridgman S, Dobbins J, Casbard A. The value national hysterectomy study: Description of the patients and their. BJOG 2002; 109: 302-12.
- Shergill SK, Shergill HK, Gupta M, Kaur S. Clinicopathological study of hysterectomies. J Indian Med Assoc 2002; 100: 238-9.
- Ojeda VJ. The pathology of hysterectomy specimens. Z Med J 1979; 89: 169-71. Talukder SI, Haque MA, Huq MH, Alam MO, Roushan A, Noor Z, Nahar K. Histopathological analysis of hysterectomy specimens. Mymensing Med J 2007; 16: 81-4.
- Arif A, Jamal S, Mubarik A, Zubair A, Ghori UK. Study of adenomyosis in different decades of life: An experience at army medical college, RawalpindiPakistan. Pak J Pathol 2007; 18: 75-8.
- Lee NC, Dicker RC, Rubin GL, Ory HW. Confirmation of the preoperative diagnoses for hysterectomy. Am J Obstet Gynecol 1984; 150: 283-7.
- Ferenczy A. Pathophysiology of adenomyosis. Hum Reprod Update 1998; 4: 312Leyendecker G, Wildt L, Mall G. The pathophysiology of endometriosis and adenomyosis: Tissue injury and repair. Arch Gynecol Obstet 2009; 280: 529-38. Bird CC, McElin TW, Manalo-Estrella P. The elusive adenomyosis of the uterus-revisited. Am J Obstet Gynecol 1972; 112: 583-93.
- Kitawaki J. Adenomyosis: the pathophysiology of an oestrogen-dependent disease. Best Pract Res Clin Obstet Gynecol 2006; 20: 493-502.
- Sherman ME, Mazur MT, Kurman RJ. Benign diseases of the endometrium. In: Kurman RJ, editor. Blaunstein’s pathology of the female genital tract. 5. edition. New York: Springer 2002; 421-66.
- Perez-Medina T, Martinez O, Folgueira G, Bajo J. Which endometrial polyps should be resected? J Am Assoc Gynecol Laparosc 1999; 6: 71-4.
- Reslova T, Tosner J, Resl M, Kugler R, Vavrova I. Endometrial polyps. A clinical study of 245 cases. Arch Gynecol Obstet 1999; 262: 133-9.
- Bukhari U, Sadiq S. Analysis of the underlying pathological lesions in hysterectomy specimens. Pak J Pathol 2007; 18: 110-2.
- Stock RJ, Kanbour A. Prehysterectomy curretage. Obstet Gynecol 1975; 45: 537
- Lerner HM. Lack of efficacy of prehysterectomy curettage as a diagnostic procedure. Am J Obstet Gynecol 1984; 148: 1055-6.
- Stovall TG, Soloman SK, Ling FW. Endometrial sampling prior to hysterectomy. Obstet Gynecol 1989; 73:405-9.
Öz
Amaç. Kliniğimizde gerçekleştirilen histerektomi operasyonlarının klinik endikasyonlarını incelemek ve histerektomi materyallerindeki histopatolojik tanıları ortaya koymaktır. Yöntem. Ocak 2010-Ocak 2013 tarihleri arasında gerçekleştirilen 223 total abdominal histerektomi olgusu retrospektif olarak incelendi. Yaş, menapozal durum, operasyon endikasyonu, yapılan operasyonun bilgileri ve elde edilen materyalin patolojik inceleme sonuçları analiz edildi. Bulgular. Çalışmaya alınan hastaların yaş ortalaması 49,3±5,4 olarak saptandı. Tüm vakalara total abdominal histerektomi uygulanmıştı. Hastaların %76,2’sine bilateral ooferektomi, %17,4’üne tek taraflı ooferektomi, %6,2’sine ise sadece histerektomi uygulanmıştı. Hastaların %19,2’si menapoz olarak değerlendirildi. Histerektomi endikasyonlarımız arasında en sık izlenen 138 hasta (%61,8) ile myoma uteri idi. Diğer endikasyonlar ise sırasıyla 38 hasta (%17) ile disfonksiyone uterin kanama, 37 hasta (%16,5) ile adneksiyel kitle, 10 hasta (%4,4) ile pelvik organ prolapsusu idi. Histerektomi materyallerinin histopatolojik incelemesi sonucunda, en yaygın tanımlanan patolojiler sırasıyla %68,1 , %37,2 , %18,8 oranlarıyla leiomyom, adenomyozis ve overyan/paraoveryan kist olarak belirlendi. En sık görülen kombinasyon %15,2 ile leiomyom ve adenomyozis kombinasyonuydu. Ayrıca 19 hastada (%8,5) endometrial polip, 15 hastada (%6,7) endometrial hiperplazi, 11 hastada (%4,9) atrofik endometrium, 4 hastada (%1,7) servikal intraepitelyal neoplazi, 3 hastada (%1,3) endometrium kanseri saptandı. Sonuç. Çalışmamızda en sık histerektomi endikasyonu literatürdeki gibi myoma uteri olarak saptandı. Histopatolojik inceleme sonucunda ise en sık leiomyom ve adenomyozis saptandı. Menometroraji/pelvik ağrı şikayeti ile başvuran ve özellikle myoma uterisi olan hastalarda eşlik eden adenomyozis olabileceği akılda tutulmalıdır. Fertilitesini tamamlamış perimenapozal ve postmenapozal kadınlarda gerek pelvik ağrı, gerekse menometrorajiye sebep olan myomların tedavisinde halen en fazla histerektomi tercih edilmektedir.
Anahtar Kelimeler
Kaynakça
- Rock JA, Jones HW III, Histerektomi, In: Te Linde’s Operatif Jinekoloji 9. Basım, Çeviri Editörü: Erol Tavmergen, İzmir Güven Kitabevi 2005; 31: 731-55. Coulter A, Bradlow J, Agass M, Martin-Bates C, Tulloch A. Outcomes of referrals to gynaecology outpatient clinics for menstrual problems: An audit of general practice records. Br J Obstet Gynaecol 1991; 98: 789-96.
- Davies A, Magos AL. Indications and alternatives to hysterectomy. Baillieres Clin Obstet Gynaecol 1997; 11: 61-75.
- Bren L. Alternatives to hysterectomy. New technologies, more options. FDA Consum. 2001; 35: 23-8.
- Marana R, Busacca M, Zupi E, Garcea N, Paparella P, Catalano GF. Laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy: A prospective, randomized, multicenter study. Am J Obstet Gynecol 1999; 180: 270-5.
- Kovac SR, Barhan S, Lister M, Tucker L, Bishop M, Das A. Guidelines for the selection of the route of hysterectomy: application in a resident clinic population. Am J Obstet Gynecol 2002; 187: 1521-7.
- Speroff T, Dawson NV, Speroff L, Haber RJ. A risk-benefit analysis of elective bilateral oophorectomy: effect of changes in compliance with estrogen therapy on outcome. Am J Obstet Gynecol 1991; 164: 165-74.
- Vessey MP, Villard-Mackintosh L, McPherson K, Coulter A, Yeates D. The epidemiology of hysterectomy: Findings in a large cohort study. British J Obstet Gynecol 1992; 99: 402-7.
- Dicker RC, Greenspan JR, Strauss LT, Cowart MR, Scally MJ, Peterson HB, DeStefano F, Rubin GL, Ory HW. Complications of abdominal and vaginal hysterectomy among women of reproductive age in the United States. The Collaborative Review of Sterilization. Am J Obstet Gynecol 1982; 144: 841-8.
- García CR, Cutler WB. Preservation of the ovary: A reevaluation. Fertil Steril 1984; 42: 510-4.
- Grundsell H, Ekman G, Gullberg B, Johnsson JE, Larsson G, Lindahl B, Möller T, Trope C. Some aspects of prophylactic oophorectomy and ovarian carcinoma. Ann Chir Gynaecol 1981; 70: 36-42.
- Cole P, Berlin J. Elective hysterectomy. Am J Ostet Gynecol 1977; 129: 177-23. Tazegül A, Acar A. Kliniğimizde Gerçekleştirilen Histerektomi Olgularının Klinik ve Demografik Özelliklerinin Değerlendirilmesi. Selçuk Tıp Dergisi 2010; 26: 19-22.
- Wilcox LS, Koonin LM, Pokras R, Strauss LT, Xia Z, Peterson HB. Hysterectomy in the United States, 1988-1990. Obstet Gynecol 1994; 83: 549-55. Maresh MJ, Metcalfe MA, McPherson K, Overton C, Hall V, Hargreaves J, Bridgman S, Dobbins J, Casbard A. The value national hysterectomy study: Description of the patients and their. BJOG 2002; 109: 302-12.
- Shergill SK, Shergill HK, Gupta M, Kaur S. Clinicopathological study of hysterectomies. J Indian Med Assoc 2002; 100: 238-9.
- Ojeda VJ. The pathology of hysterectomy specimens. Z Med J 1979; 89: 169-71. Talukder SI, Haque MA, Huq MH, Alam MO, Roushan A, Noor Z, Nahar K. Histopathological analysis of hysterectomy specimens. Mymensing Med J 2007; 16: 81-4.
- Arif A, Jamal S, Mubarik A, Zubair A, Ghori UK. Study of adenomyosis in different decades of life: An experience at army medical college, RawalpindiPakistan. Pak J Pathol 2007; 18: 75-8.
- Lee NC, Dicker RC, Rubin GL, Ory HW. Confirmation of the preoperative diagnoses for hysterectomy. Am J Obstet Gynecol 1984; 150: 283-7.
- Ferenczy A. Pathophysiology of adenomyosis. Hum Reprod Update 1998; 4: 312Leyendecker G, Wildt L, Mall G. The pathophysiology of endometriosis and adenomyosis: Tissue injury and repair. Arch Gynecol Obstet 2009; 280: 529-38. Bird CC, McElin TW, Manalo-Estrella P. The elusive adenomyosis of the uterus-revisited. Am J Obstet Gynecol 1972; 112: 583-93.
- Kitawaki J. Adenomyosis: the pathophysiology of an oestrogen-dependent disease. Best Pract Res Clin Obstet Gynecol 2006; 20: 493-502.
- Sherman ME, Mazur MT, Kurman RJ. Benign diseases of the endometrium. In: Kurman RJ, editor. Blaunstein’s pathology of the female genital tract. 5. edition. New York: Springer 2002; 421-66.
- Perez-Medina T, Martinez O, Folgueira G, Bajo J. Which endometrial polyps should be resected? J Am Assoc Gynecol Laparosc 1999; 6: 71-4.
- Reslova T, Tosner J, Resl M, Kugler R, Vavrova I. Endometrial polyps. A clinical study of 245 cases. Arch Gynecol Obstet 1999; 262: 133-9.
- Bukhari U, Sadiq S. Analysis of the underlying pathological lesions in hysterectomy specimens. Pak J Pathol 2007; 18: 110-2.
- Stock RJ, Kanbour A. Prehysterectomy curretage. Obstet Gynecol 1975; 45: 537
- Lerner HM. Lack of efficacy of prehysterectomy curettage as a diagnostic procedure. Am J Obstet Gynecol 1984; 148: 1055-6.
- Stovall TG, Soloman SK, Ling FW. Endometrial sampling prior to hysterectomy. Obstet Gynecol 1989; 73:405-9.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Cerrahi Tıp Bilimleri Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 15 Mart 2013 |
| Yayımlandığı Sayı | Yıl 2013Cilt: 35 Sayı: 3 |