绝经前期与绝经后期患者宫腔镜子宫肌瘤剜除术后感染发生率和危险因素分析

The incidence rate and risk factors associated with postoperative reproductive tract infection after hysteroscopic myomectomy in premenopausal or postmenopausal women

摘要:

目的 该文旨在分析绝经前期与绝经后期患者经阴道宫腔镜子宫肌瘤剜除术（TCRM）后生殖道感染的发生率和相关危险因素。方法 回顾性分析2013年1月－2018年6月于该院妇产科进行TCRM的患者1 068例，根据病史记录分为绝经前期和绝经后期，收集患者的基本资料、肌瘤直径、手术方式、Haarlem肌瘤类型、体重指数（BMI）、血清雌激素水平、子宫内膜周期、术前有无合并贫血、有无合并糖尿病、既往生殖道感染史、宫颈分泌物pH值、宫内节育器安置情况、术后抗生素使用和并发症等。宫腔镜术后感染为存在发热或血常规提示白细胞增加，同时宫颈或阴道分泌物病原学检查出典型病原体。通过??²检验和Logistic回归分析，对绝经前期和绝经后期患者的临床资料、术后感染发生率和危险因素进行统计学分析。结果 基线资料显示，绝经前期患者阴道分泌物pH值低于绝经后期患者，术前合并贫血、血清雌激素水平、宫内节育器安置率和行单纯TCRM者均高于绝经后期患者。绝经后患者术后感染发生率明显高于绝经前患者，差异有统计学意义（P = 0.004）。Logistic回归分析提示，对于绝经前期患者，术前阴道分泌物pH值和手术方式是TCRM术后发生感染的独立危险因素。绝经后期患者的肿瘤直径、术前合并贫血、术前合并糖尿病和术后抗生素使用是术后感染的独立危险因素。结论 绝经后期TCRM术后感染率明显高于绝经前期患者，绝经前期与绝经后期子宫肌瘤患者TCRM术后感染发生的危险因素存在差异。

Abstract:

Objective To investigate the incidence rate and risk factors of genital tract infections in patients with premenopausal or postmenopausal women underwent hysteroscopic transcervical resection of myoma (TCRM).Methods A retrospective analysis of 1068 patients underwent hysteroscopic myomectomy from 2013 to 2018 were performed. The patients were divided into premenopausal patients and postmenopausal patients according to the medical history records. Clinical baseline characteristics, size of myoma, diameter of surgery, type of Haarlem fibroids, body mass index, serum estrogen levels, endometrial cycle, presence or absence of diabetes and preoperative anemia, history of genital tract infection, pH value of cervical secretion, placement of the intrauterine device, postoperative antibiotic use, and postoperative complications were recorded. Hysteroscopic surgery associated infection was defined as the presence of fever or an increase in white blood cells at least combination with detected typical pathogens according to pathological examination of the cervix or vaginal secretions. Statistical analysis of baseline data, postoperative infection rates, and risk factors for premenopausal and postmenopausal patients by Chi-square test and logistic regression analysis respectively.Results Baseline data showed that vaginal secretion pH value was lower than those in postmenopausal patients, preoperative anemia ratio, serum estrogen level, intrauterine device placement rate, and the proportion of patients with simple submucosal myoma were higher than those in postmenopausal patients. The incidence of postoperative infection in postmenopausal patients was significantly higher than that in premenopausal patients, and the statistical difference was significant (P = 0.004). Logistic regression analysis suggests that for premenopausal patients, preoperative vaginal secretion PH values and surgical procedures are independent risk factors for postoperative TCRM infection. The size of the tumor in the postmenopausal patients, preoperative anemia combined with preoperative diabetes, postoperative antibiotic use is an independent risk factor for postoperative infection.Conclusion The incidence of reproductive tract infection after TCRM in the postmenopausal patients is significantly higher than that in premenopausal patients. There are differences in the risk factors of postoperative genital tract infection in premenopausal and late uterine fibroids.