Morgan Daniel M, Rogers Mary A M, Huebner Markus, Wei John T, Delancey John O
Departments of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan 48109, USA.
Obstet Gynecol. 2007 Jun;109(6):1424-33. doi: 10.1097/01.AOG.0000264066.89094.21.
To explore why failure rates vary so much between published reports of sacrospinous ligament fixation to correct pelvic organ prolapse and what the potential sources of heterogeneity may be.
MEDLINE was queried for studies between 1966 and 2005 that included the term "sacrospinous."
One-hundred eighty-seven studies were reviewed. Studies were selected if they 1) involved a surgical procedure performed unilaterally with a posterior or apical vaginal incision and approach to the ligament; 2) reported objective outcomes with a classification system (Baden-Walker, pelvic organ prolapse quantification) over a defined follow-up period; and 3) were published in English, French, or German. Random effects meta-analyses were conducted for both objective and subjective measures of failure.
TABULATION, INTEGRATION, AND RESULTS: Seventeen cohorts met the selection criteria, and the Baden-Walker vaginal profile or a close variation suitable for meta-analysis was used in 10 of them. Variability in failure rates was observed depending on site of and grade of vaginal support (P<.05). The anterior compartment was the most common site of failure for any given grade. This was most striking when the criterion for failure was grade 1 (40.1% anterior, 11.0% apical, 18.2% posterior) or grade 2 prolapse (21.3% anterior, 7.2% apical, 6.3% posterior). Areas of vaginal support were more equally affected when the criterion for failure was grade 3 prolapse (3.7% anterior, 2.7% apical, 2.3% posterior). Among cohorts using grade 2 prolapse as the criterion for objective failure, the pooled measure of failure to relieve symptoms was 10.3% (95% confidence interval 4.4-16.2%) and to provide patient satisfaction was 13.0% (95% confidence interval 7.4-18.6%).
The variation in published failure rates after sacrospinous ligament fixation is, in part, accounted for by differences in how anatomical outcomes are evaluated and which compartment of vaginal support is being considered. Failure rates are highest in the anterior compartment.
探讨在已发表的关于骶棘韧带固定术治疗盆腔器官脱垂的报告中，失败率为何差异如此之大，以及异质性的潜在来源可能是什么。
检索MEDLINE中1966年至2005年间包含“骶棘”一词的研究。
对187项研究进行了综述。入选的研究需满足以下条件：1）涉及通过后阴道或顶端阴道切口单侧进行的手术操作及对韧带的处理；2）在规定的随访期内采用分类系统（巴登-沃克分类法、盆腔器官脱垂定量法）报告客观结果；3）以英文、法文或德文发表。对失败的客观和主观指标均进行随机效应荟萃分析。
制表、整合及结果：17个队列符合选择标准，其中10个队列使用了巴登-沃克阴道轮廓或适合荟萃分析的相近变体。根据阴道支持的部位和分级观察到失败率存在差异（P<0.05）。对于任何给定分级，前盆腔是最常见的失败部位。当失败标准为1级（前盆腔40.1%、顶端11.0%、后盆腔部18.2%）或2级脱垂（前盆腔21.3%、顶端7.2%、后盆腔部6.3%）时，这种情况最为明显。当失败标准为3级脱垂时，阴道支持的各部位受影响程度更为均等（前盆腔3.7%、顶端2.7%、后盆腔部2.3%）。在以2级脱垂作为客观失败标准的队列中，缓解症状失败的合并测量值为10.3%（95%置信区间4.4 - 16.2%），患者满意度失败的合并测量值为13.0%（95%置信区间7.4 - 18.6%）。
骶棘韧带固定术后已发表的失败率差异，部分原因在于解剖学结果评估方式的不同以及所考虑的阴道支持部位不同。前盆腔的失败率最高。
