Ontology type: schema:ScholarlyArticle
2009-03
AUTHORSL. Mamy, V. Letouzey, N. Chevalier, J. Gondry, P. Mares, R. de Tayrac
ABSTRACTL’hystérectomie est la deuxième intervention la plus fréquente de la région abdominopelvienne en France, après la césarienne. Trois voies d’abord existent: la voie vaginale, la voie coelioscopique et la laparotomie. Les complications per-opératoires et le devenir des patientes à court terme ont bien été décrites. L’objectif de cet article est d’analyser les risques de séquelles vésicosphinctériennes, anorectales et génitosexuelles de l’hystérectomie à moyen et long terme. Cette mise au point est basée sur les données de la Cochrane Database et de Medline. Les mots clés utilisés ont été hysterectomy, urinary incontinence, constipation, dyspareunia, et sequelae. La période couverte va de 1985 à 2008. Ne sont pas pris en compte dans cette analyse les risques de prolapsus secondaire et les hystérectomies pour pathologie maligne (10 % des hystérectomies). Les séquelles vésicosphinctériennes existent, et l’hystérectomie expose à un risque d’incontinence urinaire à long terme. Concernant les séquelles anorectales, les données de la littérature sont plus contradictoires. Elles sont probablement minimes. Quant aux conséquences génitosexuelles, l’association à une annexectomie bilatérale chez des patientes non ménopausées peut entraîner une difficulté d’adaptation à la carence hormonale, comme en début deménopause. La voie d’abord de l’hystérectomie pour pathologie bénigne pourrait avoir un retentissement psychosexuel, au bénéfice des voies coelioscopique et vaginale. Il n’y a pas d’intérêt en la conservation du col utérin. L’hystérectomie, quelle que soit sa voie d’abord, entraîne des risques de séquelles sur le long terme, en particulier, urinaires et psychosexuelles. Les voies d’abord vaginale et coelioscopique sont à privilégier par rapport à la laparotomie. Il n’y a pas d’intérêt à la conservation du col utérin. Un nouveau débat est ouvert sur la préservation de l’utérus chez les jeunes femmes en chirurgie du prolapsus. Toutefois, des recherches approfondies sont nécessaires, en particulier sur le long terme, par de larges essais randomisés visant à réduire aumaximum les biais. D’autres recherches sont également nécessaires pour définir le rôle des nouvelles approches de l’hystérectomie telles que l’hystérectomie totale par laparoscopie. More... »
PAGES22-30
http://scigraph.springernature.com/pub.10.1007/s11608-009-0222-4
DOIhttp://dx.doi.org/10.1007/s11608-009-0222-4
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"description": "L\u2019hyst\u00e9rectomie est la deuxi\u00e8me intervention la plus fr\u00e9quente de la r\u00e9gion abdominopelvienne en France, apr\u00e8s la c\u00e9sarienne. Trois voies d\u2019abord existent: la voie vaginale, la voie coelioscopique et la laparotomie. Les complications per-op\u00e9ratoires et le devenir des patientes \u00e0 court terme ont bien \u00e9t\u00e9 d\u00e9crites. L\u2019objectif de cet article est d\u2019analyser les risques de s\u00e9quelles v\u00e9sicosphinct\u00e9riennes, anorectales et g\u00e9nitosexuelles de l\u2019hyst\u00e9rectomie \u00e0 moyen et long terme. Cette mise au point est bas\u00e9e sur les donn\u00e9es de la Cochrane Database et de Medline. Les mots cl\u00e9s utilis\u00e9s ont \u00e9t\u00e9 hysterectomy, urinary incontinence, constipation, dyspareunia, et sequelae. La p\u00e9riode couverte va de 1985 \u00e0 2008. Ne sont pas pris en compte dans cette analyse les risques de prolapsus secondaire et les hyst\u00e9rectomies pour pathologie maligne (10 % des hyst\u00e9rectomies). Les s\u00e9quelles v\u00e9sicosphinct\u00e9riennes existent, et l\u2019hyst\u00e9rectomie expose \u00e0 un risque d\u2019incontinence urinaire \u00e0 long terme. Concernant les s\u00e9quelles anorectales, les donn\u00e9es de la litt\u00e9rature sont plus contradictoires. Elles sont probablement minimes. Quant aux cons\u00e9quences g\u00e9nitosexuelles, l\u2019association \u00e0 une annexectomie bilat\u00e9rale chez des patientes non m\u00e9nopaus\u00e9es peut entra\u00eener une difficult\u00e9 d\u2019adaptation \u00e0 la carence hormonale, comme en d\u00e9but dem\u00e9nopause. La voie d\u2019abord de l\u2019hyst\u00e9rectomie pour pathologie b\u00e9nigne pourrait avoir un retentissement psychosexuel, au b\u00e9n\u00e9fice des voies coelioscopique et vaginale. Il n\u2019y a pas d\u2019int\u00e9r\u00eat en la conservation du col ut\u00e9rin. L\u2019hyst\u00e9rectomie, quelle que soit sa voie d\u2019abord, entra\u00eene des risques de s\u00e9quelles sur le long terme, en particulier, urinaires et psychosexuelles. Les voies d\u2019abord vaginale et coelioscopique sont \u00e0 privil\u00e9gier par rapport \u00e0 la laparotomie. Il n\u2019y a pas d\u2019int\u00e9r\u00eat \u00e0 la conservation du col ut\u00e9rin. Un nouveau d\u00e9bat est ouvert sur la pr\u00e9servation de l\u2019ut\u00e9rus chez les jeunes femmes en chirurgie du prolapsus. Toutefois, des recherches approfondies sont n\u00e9cessaires, en particulier sur le long terme, par de larges essais randomis\u00e9s visant \u00e0 r\u00e9duire aumaximum les biais. D\u2019autres recherches sont \u00e9galement n\u00e9cessaires pour d\u00e9finir le r\u00f4le des nouvelles approches de l\u2019hyst\u00e9rectomie telles que l\u2019hyst\u00e9rectomie totale par laparoscopie.",
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"name": "Pelvi-p\u00e9rin\u00e9ologie",
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"name": "S\u00e9quelles v\u00e9sicosphinct\u00e9riennes, anorectales et g\u00e9nitosexuelles de l\u2019hyst\u00e9rectomie",
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