Unger Cecile A, Walters Mark D
From the Center for Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH.
Female Pelvic Med Reconstr Surg. 2014 Jul-Aug;20(4):208-11. doi: 10.1097/SPV.0000000000000091.
Sacrospinous ligament (SSL) colpopexy is a transvaginal surgical option for the treatment of vaginal apex prolapse. The objective of this study was to determine the rate of gluteal and posterior thigh pain after SSL colpopexy using the Capio device in the immediate postoperative period, at the 6-week postoperative visit, and to determine the risk of needing intervention for this type of pain.
This was a retrospective cohort study of women who underwent SSL colpopexy with the Capio device for the treatment of vaginal apex prolapse between 2007 and 2012. The electronic inpatient and outpatient medical record was queried for demographic, intraoperative, and immediate and 6-week postoperative data.
Two hundred forty-two subjects underwent SSL colpopexy with the Capio device for vaginal apex prolapse. Mean age and body mass index were 66 (10) years and 28.7 (5.4) kg/m, respectively. One hundred thirty-four (55.4%) subjects were found to have immediate gluteal or posterior thigh pain and 36 (15.3%) were found to have persistent pain at 6 weeks. Five (2.1%; 95% confidence interval, 0.8%-4.7%) subjects required intervention: physical therapy (3), trigger point injection (1), both (1), and no patients required reoperation. Concomitant midurethral sling placement was associated with pain at 6 weeks (P = 0.008). Need for intervention was associated with the number of sutures placed (2 or 3 vs 4; P = 0.03). Concomitant hysterectomy and approach to SSL colpopexy were not associated with gluteal or posterior thigh pain.
The rate of immediate postoperative gluteal and posterior thigh pain is high in patients undergoing SSL colpopexy for vaginal apex prolapse; however, the rate of pain at 6 weeks is much lower, and the need for intervention is even lower.
骶棘韧带（SSL）阴道固定术是治疗阴道顶端脱垂的一种经阴道手术选择。本研究的目的是确定使用Capio装置进行SSL阴道固定术后即刻、术后6周时臀肌和大腿后侧疼痛的发生率，并确定针对此类疼痛需要进行干预的风险。
这是一项回顾性队列研究，研究对象为2007年至2012年间接受Capio装置SSL阴道固定术治疗阴道顶端脱垂的女性。查询电子住院和门诊病历以获取人口统计学、术中、术后即刻及术后6周的数据。
242名受试者接受了Capio装置SSL阴道固定术治疗阴道顶端脱垂。平均年龄和体重指数分别为66（10）岁和28.7（5.4）kg/m²。134名（55.4%）受试者术后即刻出现臀肌或大腿后侧疼痛，36名（15.3%）受试者在术后6周仍有持续性疼痛。5名（2.1%；95%置信区间，0.8%-4.7%）受试者需要干预：物理治疗（3名）、触发点注射（1名）、两者皆用（1名），且无患者需要再次手术。同期放置尿道中段吊带与术后6周疼痛相关（P = 0.008）。需要干预与所放置缝线数量有关（2或3根与4根；P = 0.03）。同期子宫切除术及SSL阴道固定术的手术入路与臀肌或大腿后侧疼痛无关。
接受SSL阴道固定术治疗阴道顶端脱垂的患者术后即刻出现臀肌和大腿后侧疼痛的发生率较高；然而，术后6周疼痛发生率低得多，需要干预的情况甚至更少。
