Hysterectomy is a surgical procedure used to remove all or part of the uterine tissue. This operation is primarily employed to treat severe uterine-related conditions such as uterine fibroids, adenomyosis, or cervical cancer. The surgery can eradicate diseased tissue and alleviate symptoms like chronic pain and abnormal bleeding. However, since it is a permanent procedure, it is usually considered only after other treatments have failed.
Based on the patient's age, severity of the disease, and reproductive needs, physicians will evaluate the most appropriate type of hysterectomy. The procedure may impact fertility, and patients should communicate thoroughly with their healthcare team to confirm their treatment preferences.
Hysterectomy is mainly classified into total hysterectomy, subtotal hysterectomy, and radical hysterectomy. Total hysterectomy involves removing the entire uterus and cervix; subtotal hysterectomy preserves the cervix but removes the uterine body; radical hysterectomy extends the removal to surrounding tissues and is often used in cancer treatment.
The surgical approaches include traditional open surgery, laparoscopic-assisted surgery, and robot-assisted surgery. Laparoscopic surgery involves small incisions for instrument insertion, resulting in less trauma and faster recovery; robotic systems enhance precision but require adaptation based on patient physique. During surgery, ovaries may be preserved or removed depending on the patient's age and hormonal needs.
This procedure is mainly indicated for cases such as uterine fibroids causing severe bleeding or compression symptoms, adenomyosis resistant to medication, or endometriosis leading to organ adhesions. When malignant tumors like cervical cancer or uterine sarcoma have spread to the uterine body, hysterectomy becomes a necessary treatment.
Other indications include uterine prolapse causing bladder or bowel dysfunction, and cases where uterine bleeding cannot be controlled with medication or endoscopic treatment. However, contraindications such as uncontrolled infections or coagulation disorders must be ruled out before proceeding.
Preoperative assessments include ultrasound, hysteroscopy, or tissue biopsy to confirm the extent of the lesion. The surgery typically lasts 2 to 4 hours under general anesthesia. Postoperative hospitalization lasts 3 to 7 days, with recovery periods ranging from 1 to 6 weeks depending on the surgical method.
The choice of surgical route depends on uterine size and lesion location: open surgery is suitable for large fibroids or severe adhesions; laparoscopy is ideal for early-stage conditions; robotic systems can precisely handle complex anatomy. Postoperative hormone therapy may be necessary to alleviate menopausal symptoms.
This surgery can permanently eliminate uterine lesions, providing a definitive solution for patients with fibroids or adenomyosis unresponsive to medication. Laparoscopic or robotic-assisted methods reduce tissue damage, shorten recovery time, and lower infection risk.
Radical hysterectomy effectively removes cancer cells in cervical cancer patients and, combined with lymph node dissection, reduces recurrence risk. It also addresses severe uterine prolapse complications affecting urinary or digestive functions, thereby improving quality of life.
Potential complications include intraoperative bleeding, ureter or bladder injury, with an incidence of about 1-3%. Short-term postoperative risks include infection and thrombosis; long-term effects may involve pelvic adhesions or early menopause symptoms.
Serious Risks: Damage to the uterine artery may cause significant bleeding requiring immediate vascular ligation or transfusion. Injury to the parametrial nerves can result in sexual dysfunction or urinary difficulties, necessitating postoperative rehabilitation.
Pregnant women, those with severe coagulation disorders, or uncontrolled uterine infections are contraindicated. Preoperative assessments should include cardiopulmonary evaluation; patients with diabetes or cardiovascular diseases should control underlying conditions beforehand. Heavy lifting and sexual activity are prohibited within 6 weeks post-surgery.
If patients undergo uterine artery embolization concurrently, a minimum interval of 3 months before surgery is recommended. Previous pelvic radiation therapy may increase adhesion risk; patients should inform their medical team beforehand.
Postoperative hormone therapy should be tailored based on ovarian preservation: if ovaries are retained, natural hormone levels can be maintained; if removed, estrogen supplementation may be necessary, with cardiovascular risks evaluated prior to use.
Clinical studies show that hysterectomy achieves over 95% symptom relief in fibroid cases and 80-90% pain improvement in adenomyosis. Radical hysterectomy for stage I cervical cancer can attain a 5-year survival rate exceeding 90%.
Laparoscopic surgery reduces hospital stay by 50% and complication rates to 1.2% compared to traditional open surgery. Long-term follow-up indicates over 85% patient satisfaction regarding quality of life improvements.
Uterine fibroids can be treated with uterine artery embolization or focused ultrasound therapy; adenomyosis may be managed with GnRH analogs. Uterine prolapse can be addressed with uterine suspension or pelvic floor reconstruction.
Conservative treatments include uterine-preserving medications or ablation procedures, which may require regular follow-up. Patients should evaluate lesion malignancy and reproductive needs with their physicians to choose the most suitable treatment approach.
Preoperative assessments include comprehensive physical examinations, blood tests, cardiopulmonary evaluations, and imaging studies (such as ultrasound or MRI) to confirm the condition of the uterus and surrounding tissues. Patients should stop anticoagulant medications and discuss anesthesia options and surgical types with their doctor. Psychological preparation is also important; consulting with a counselor can help reduce anxiety.
How long does it take to recover and resume normal activities after surgery?Recovery time varies by surgical method: laparoscopic surgery typically takes 2-4 weeks; open surgery may require 6-8 weeks. During the initial period, heavy lifting and strenuous activities should be avoided, but light activities like walking can gradually be increased. Doctors will adjust rehabilitation plans based on recovery progress; patients should strictly follow medical advice to prevent complications.
Will hysterectomy affect hormonal levels?If the ovaries are also removed, estrogen levels will drop sharply, potentially causing menopause symptoms such as hot flashes and osteoporosis. If ovaries are preserved, hormonal effects are minimal, but there may be temporary fluctuations due to surgical trauma. Doctors may recommend hormone replacement therapy or calcium supplementation to maintain bone and overall health.
Is cervical cancer screening still necessary after hysterectomy?If the entire uterus (including the cervix) is removed and there is no history of cervical cancer, routine cervical screening is generally unnecessary. However, if only the uterine body is removed or there is a precancerous condition, continued follow-up may be advised. Patients should confirm personalized screening plans with their doctor post-surgery.
Will the surgery affect sexual function? How can it be improved?Some patients may experience changes in libido or comfort due to tissue removal or hormonal changes, but not all cases are affected. Doctors may suggest lubricants or topical estrogen therapy to improve tissue elasticity. Psychological counseling and communication with partners can also help alleviate anxiety and restore sexual quality of life.
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