腹腔镜子宫切除术后三年健康相关生活质量变化：一项基于登记的队列研究

原文

STUDY OBJECTIVE: To evaluate changes in health-related quality of life (HRQoL) 3 years after laparoscopic hysterectomy (LH) for benign, prophylactic, and malignant indications, and to identify baseline factors associated with these changes. DESIGN: Registry-based observational cohort study with longitudinal patient-reported outcomes. SETTING AND PARTICIPANTS: Women undergoing LH at 5 Norwegian hospitals between 2019 and 2020. INTERVENTIONS: LH for benign, prophylactic, or malignant indications. MEASUREMENTS: HRQoL was assessed preoperatively and at 3 years using the RAND-36 across 8 domains (0-100; higher scores indicating better health). MAIN RESULTS: Of 939 eligible women, 575 (61%) responded at 3 years. Indications were benign disease (n = 445, 77.4%), prophylactic surgery (n = 71, 12.3%), and malignancy (n = 59, 10.3%). Women with benign conditions showed significant improvements in bodily pain (mean difference (MD): 12.1, 95% confidence interval (CI): 9.3, 14.9) and physical role limitations (MD: 10.9, CI: 6.3, 15.5) (both p ≤ .001), with consistent effects across subgroups. Prophylactic surgery showed no significant changes. Malignant indications had mixed outcomes: physical functioning declined (MD: 9.5, CI: -14.9, -4.1, p ≤ .001), while mental health improved (MD: 7.2, CI: 1.8, 12.5, p = .009). Among benign cases, higher baseline HRQoL predicted less improvement (regression coefficient β = -8.0 to -4.6, p <.001). CONCLUSION: Three years after LH, changes in HRQoL outcomes varied by indication. Women with benign conditions showed significant improvements, while prophylactic surgery showed no significant change and malignant indications yielded mixed effects. Baseline HRQoL was the strongest predictor of long-term change, highlighting its importance in preoperative counseling.