Özhan ÖZDEMİR, Deha Denizhan KESKİN, Seda KESKİN

Histerektomi endikasyonları ve histopatolojik tanıların dağılımı

Amaç. Kliniğimizde gerçekleştirilen histerektomi operasyonlarının klinik endikasyonlarınıincelemek ve histerektomi materyallerindeki histopatolojik tanıları ortaya koymaktır. Yöntem.Ocak 2010-Ocak 2013 tarihleri arasında gerçekleştirilen 223 total abdominal histerektomi olgusuretrospektif olarak incelendi. Yaş, menapozal durum, operasyon endikasyonu, yapılanoperasyonun bilgileri ve elde edilen materyalin patolojik inceleme sonuçları analiz edildi.Bulgular. Çalışmaya alınan hastaların yaş ortalaması 49,3±5,4 olarak saptandı. Tüm vakalara totalabdominal histerektomi uygulanmıştı. Hastaların %76,2sine bilateral ooferektomi, %17,4üne tektaraflı ooferektomi, %6,2sine ise sadece histerektomi uygulanmıştı. Hastaların %19,2si menapozolarak değerlendirildi. Histerektomi endikasyonlarımız arasında en sık izlenen 138 hasta (%61,8)ile myoma uteri idi. Diğer endikasyonlar ise sırasıyla 38 hasta (%17) ile disfonksiyone uterinkanama, 37 hasta (%16,5) ile adneksiyel kitle, 10 hasta (%4,4) ile pelvik organ prolapsusu idi.Histerektomi materyallerinin histopatolojik incelemesi sonucunda, en yaygın tanımlananpatolojiler sırasıyla %68,1 , %37,2 , %18,8 oranlarıyla leiomyom, adenomyozis veoveryan/paraoveryan kist olarak belirlendi. En sık görülen kombinasyon %15,2 ile leiomyom veadenomyozis kombinasyonuydu. Ayrıca 19 hastada (%8,5) endometrial polip, 15 hastada (%6,7)endometrial hiperplazi, 11 hastada (%4,9) atrofik endometrium, 4 hastada (%1,7) servikalintraepitelyal neoplazi, 3 hastada (%1,3) endometrium kanseri saptandı. Sonuç. Çalışmamızda ensık histerektomi endikasyonu literatürdeki gibi myoma uteri olarak saptandı. Histopatolojikinceleme sonucunda ise en sık leiomyom ve adenomyozis saptandı. Menometroraji/pelvik ağrışikayeti ile başvuran ve özellikle myoma uterisi olan hastalarda eşlik eden adenomyozisolabileceği akılda tutulmalıdır. Fertilitesini tamamlamış perimenapozal ve postmenapozalkadınlarda gerek pelvik ağrı, gerekse menometrorajiye sebep olan myomların tedavisinde halen enfazla histerektomi tercih edilmektedir.

Hysterectomy indications and distribution of histopathological diagnoses

Aim. Examine the clinical indications for hysterectomy operations performed in our clinic and putforward the histopathologic diagnosis of hysterectomy materials. Method. 223 total abdominalhysterectomy cases performed between January 2010-January 2013 were retrospectivelyevaluated. Age, menopausal status, operation indication, the operation data and the results ofmaterials pathological examination were analyzed. Results. The mean age of the patients was49.3±5.4. All cases underwent total abdominal hysterectomy. 76.2% of the patients was performedbilateral oopherectomy, 17.4% of the patients was performed unilateral oopherectomy, 6.2% of thepatients was performed only hysterectomy. Between the hysterectomy indications the mostcommon one was leiyomyom with 138 patients (61.8 %). The other indications were dysfunctionaluterine bleeding with 38 patients (17%), adnexal masses with 37 patients (16.5%), pelvic organprolapse with 10 patients (4.4%). As the result of histopathological examinations of hysterectomymaterials, the most common pathologies are defined as leiomyom, adenomyosis, andovarian/paraovarian cyst with the rates 68.1%, 37.2%, 18.8%, respectively. The most commoncombination was leiomyom and adenomyosis combination with the ratio of 15.2%. In addition, 19patients (8.5%) were determined with endometrial polyps, 15 patients (6.7%) with endometrialhyperplasia, 11 patients (4.9%) with atrophic endometrium, 4 patients (1.7%) with cervicalintraepithelial neoplasia, 3 patients (1.3%) with endometrial cancer. Conclusion. In our study, themost common indication of hysterectomy was uterine myoma as the literature. The most commonhistopathological examination result was leiomyom and adenomyosis. Adenomyosis must be kept in mind in patients who consulted with complaint of menometrorrhagia/ pelvic pain and especiallyhaving myoma. Hysterectomy is the most preferred choice in treatment of pelvic pain and alsomyomas causing menometrorrhagia in perimenopausal with no further desire of childbearing andpostmenopausal women

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