de Boer Tiny A, Milani Alfredo L, Kluivers Kirsten B, Withagen Mariella I J, Vierhout Mark E
Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, 6500 HB Nijmegen, The Netherlands.
Int Urogynecol J Pelvic Floor Dysfunct. 2009 Nov;20(11):1313-9. doi: 10.1007/s00192-009-0945-3. Epub 2009 Aug 11.
The objective of this study is to evaluate cervical amputation with uterosacral ligament plication (modified Manchester) and compare it to vaginal hysterectomy with high uterosacral ligament plication procedure with special regard to the middle compartment.
Consecutive women with pelvic organ prolapse who underwent either vaginal hysterectomy or a modified Manchester procedure were included. Assessments were made preoperatively and at 1-year follow-up, including physical examination with pelvic organ prolapse quantification standardised questionnaires (incontinence impact questionnaire, urogenital distress inventory, and defaecatory distress inventory).
Between 2002 and 2007, 156 patients were included. Ninety-eight patients returned for a 1-year follow-up. In the modified Manchester group, we found no middle compartment recurrence versus two (4%) in the vaginal hysterectomy group. Anterior and posterior compartment prolapse recurrences (stage >or=2) were similar (approximately 50%). Considering operating time and blood loss, modified Manchester was more favourable. There was no difference in the pre- and postoperative subjective scores. The overall functional outcome was acceptable.
We found an excellent performance of both procedures regarding middle compartment recurrences.
本研究的目的是评估子宫骶韧带折叠术（改良曼彻斯特手术）的宫颈切除术，并将其与高位子宫骶韧带折叠术的阴道子宫切除术进行比较，特别关注中盆腔。
纳入连续接受阴道子宫切除术或改良曼彻斯特手术的盆腔器官脱垂女性。在术前和1年随访时进行评估，包括使用盆腔器官脱垂量化标准化问卷（失禁影响问卷、泌尿生殖系统困扰量表和排便困扰量表）进行体格检查。
2002年至2007年期间，共纳入156例患者。98例患者返回进行1年随访。在改良曼彻斯特手术组中，未发现中盆腔复发，而阴道子宫切除术组有2例（4%）复发。前后盆腔脱垂复发（≥2期）相似（约50%）。考虑手术时间和失血量，改良曼彻斯特手术更具优势。术前和术后主观评分无差异。总体功能结局可接受。
我们发现两种手术在中盆腔复发方面均表现出色。
