Zebede Salomon, Smith Aimee L, Lefevre Roger, Aguilar Vivian C, Davila G Willy
Department of Gynecology, Urogynecology & Reconstructive Pelvic Surgery, Cleveland Clinic Florida, Weston, FL 33331, USA.
Int Urogynecol J. 2013 Jan;24(1):141-5. doi: 10.1007/s00192-012-1862-4. Epub 2012 Jul 10.
We aimed to determine if the use of permanent suture for the apical fixation during traditional anterior colporrhaphy results in improved outcomes compared to delayed absorbable suture.
A retrospective case-control study was performed in patients who underwent traditional non-grafted anterior colporrhaphy with reattachment of the anterior endopelvic fascia to the apex/cervix comparing permanent (group 1) or absorbable suture (group 2). Patients were matched based on age, body mass index, and presenting stage of prolapse. The primary outcome assessed was anterior wall vaginal prolapse recurrence defined as Pelvic Organ Prolapse Quantification (POP-Q) points Aa or Ba ≥ -1 cm. Secondary outcome measures included overall prolapse stage, subjective reporting of satisfaction, and any healing abnormalities or complications resulting from suture type.
A total of 230 patients were reviewed (80 in group 1 and 150 in group 2) and median follow-up was 52 (24-174) weeks. A statistically significant improvement in anterior wall anatomy was seen in group 1 compared to group 2 [(Aa -2.70 ± 0.6 cm vs -2.5 ± 0.75 cm, p = 0.02) and Ba (-2.68 ± 0.65 cm vs -2.51 ± 0.73 cm, p = 0.03), respectively]. Comparing prolapse stage, there were no observed differences between the groups. Exposure of the permanent suture occurred in 12 patients (15 %) and 5 (6.5 %) required suture trimming to treat the exposure.
Reattachment of endopelvic fascia to the apex at the time of anterior colporrhaphy results in low recurrence rates. Use of permanent suture for apical fixation is associated with improved anatomic correction at the expense of increased suture exposures.
我们旨在确定在传统前路阴道修补术中使用永久缝线进行顶端固定与延迟可吸收缝线相比是否能带来更好的治疗效果。
对接受传统非移植前路阴道修补术且将盆腔内筋膜前端重新附着于顶端/宫颈的患者进行回顾性病例对照研究，比较使用永久缝线（第1组）或可吸收缝线（第2组）的情况。患者根据年龄、体重指数和脱垂的初始阶段进行匹配。评估的主要结局是阴道前壁脱垂复发，定义为盆腔器官脱垂定量（POP-Q）点Aa或Ba≥ -1 cm。次要结局指标包括总体脱垂阶段、满意度主观报告以及因缝线类型导致的任何愈合异常或并发症。
共纳入230例患者（第1组80例，第2组150例），中位随访时间为52（24 - 174）周。与第2组相比，第1组的阴道前壁解剖结构有统计学意义的改善[Aa分别为-2.70 ± 0.6 cm对-2.5 ± 0.75 cm，p = 0.02；Ba为-2.68 ± 0.65 cm对-2.51 ± 0.73 cm，p = 0.03]。比较脱垂阶段，两组之间未观察到差异。12例患者（15%）出现永久缝线外露，5例（6.5%）需要修剪缝线以处理外露情况。
前路阴道修补术时将盆腔内筋膜重新附着于顶端可导致低复发率。使用永久缝线进行顶端固定与更好的解剖学矫正相关，但代价是缝线外露增加。
