Ginath Shimon, Garely Alan D, Condrea Alexander, Vardy Michael D
Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai School of Medicine, New York, NY, USA.
Int Urogynecol J. 2013 Jan;24(1):113-8. doi: 10.1007/s00192-012-1845-5. Epub 2012 Jun 21.
We compared the role of abdominal sacral colpopexy (ASCP) with concomitant supracervical hysterectomy to ASCP alone in patients with prior hysterectomy in the prevention of mesh erosion.
We performed a retrospective chart review of 277 consecutive patients who underwent ASCP with one surgeon. Patients were separated into two groups based on the presence of a uterus at the time of surgery. Group A comprised195 patients with a uterus who underwent ASCP and concomitant supracervical hysterectomy; group B comprised 82 patients with prior total hysterectomy who underwent ASCP. The outcome measures included peri- and postoperative findings, complications, and surgical success. Data were analyzed by t test and chi-square test using SPSS software.
No significant difference was found between groups during surgery in terms of anesthesia type, total operative time, and estimated intraoperative blood loss. At mean postoperative follow-up of 7-8 months, there was no difference between groups in terms of de novo urinary symptoms, recurrent vaginal-wall prolapse, or dyspareunia and Pelvic Organ Prolapse Quantification (POP-Q) point C examination. Sling erosion was observed in four (4.2 %) patients in group A versus none in group B. Apical mesh erosion was diagnosed in one patient in group A (0.5 %) and two (2.4 %) patients in group B. These differences were not statistically significant.
Concomitant supracervical hysterectomy with ASCP was associated with a low incidence of mesh erosion and had the same intraoperative course and postoperative outcome as ASCP with previous hysterectomy.
我们比较了在既往接受过子宫切除术的患者中，腹骶阴道固定术（ASCP）联合次全子宫切除术与单纯ASCP在预防网片侵蚀方面的作用。
我们对一位外科医生连续实施的277例接受ASCP手术的患者进行了回顾性病历审查。根据手术时子宫的情况将患者分为两组。A组包括195例有子宫且接受ASCP联合次全子宫切除术的患者；B组包括82例既往接受过全子宫切除术且接受ASCP的患者。观察指标包括围手术期和术后的情况、并发症及手术成功率。使用SPSS软件通过t检验和卡方检验对数据进行分析。
两组在手术期间的麻醉类型、总手术时间和估计术中失血量方面无显著差异。术后平均随访7 - 8个月时，两组在新发尿路症状、复发性阴道壁脱垂、性交困难及盆腔器官脱垂定量（POP - Q）C点检查方面无差异。A组有4例（4.2%）患者出现吊带侵蚀，而B组无；A组有1例（0.5%）患者被诊断为顶端网片侵蚀，B组有2例（2.4%）。这些差异无统计学意义。
ASCP联合次全子宫切除术导致网片侵蚀的发生率较低，且与既往子宫切除术后行ASCP具有相同的术中过程和术后结局。
