Myers Erinn M, Siff Lauren, Osmundsen Blake, Geller Elizabeth, Matthews Catherine A
Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA,
Int Urogynecol J. 2015 Apr;26(4):585-9. doi: 10.1007/s00192-014-2551-2. Epub 2014 Nov 1.
Optimal management of the cervix at the time of hysterectomy and sacrocolpopexy for primary uterovaginal prolapse is unknown. Our hypothesis was that recurrent prolapse at 1 year would be more likely after a supracervical robotic hysterectomy (SRH) compared with a total robotic hysterectomy (TRH) at the time of robotic sacrocolpopexy (RSCP) for uterovaginal prolapse.
This was a retrospective cohort analysis of 83 women who underwent hysterectomy with RSCP over a 24-month period (40 with TRH and 43 with SRH). At 1 year post-procedure, subjects completed validated questionnaires regarding pelvic floor symptoms, sexual function, and global satisfaction, and underwent a pelvic examination to identify mesh exposure and evaluate pelvic floor support.
Demographics of the two groups were similar, except for a higher mean body mass index in the TRH group (31.9 TRH vs 25.8 SRH kg/m(2), p < 0.001). The rate of recurrent prolapse ≥ stage II was higher for women who underwent SRH compared with TRH (41.9 % vs 20.0 %, p = 0.03; OR 2.8, 95 % CI, 1.07-7.7). However, when this was analyzed as recurrence ≥ hymen, there was no difference between groups (12.5 % TRH vs 18.6 % SRH, p = 0.45). Likewise, there was no difference between groups when a composite measure of success was used (30 out of 40 [75 %] TRH vs 29 out of 43 [67.4 %] SRH, p = 0.45).
Women who underwent an SRH were 2.8 times more likely to have a recurrent prolapse, ≥ stage II, at 1 year, compared with those who underwent a TRH, but when composite assessment scores were used there was no difference between the groups.
对于原发性子宫阴道脱垂患者，在子宫切除术和骶骨阴道固定术时，子宫颈的最佳处理方式尚不清楚。我们的假设是，在机器人辅助骶骨阴道固定术（RSCP）治疗子宫阴道脱垂时，与全子宫机器人切除术（TRH）相比，次全子宫机器人切除术（SRH）后1年复发脱垂的可能性更大。
这是一项回顾性队列分析，研究对象为83例在24个月内接受了RSCP子宫切除术的女性（40例行TRH，43例行SRH）。术后1年，受试者完成了关于盆底症状、性功能和总体满意度的有效问卷，并接受了盆腔检查以确定网片暴露情况并评估盆底支持功能。
两组的人口统计学特征相似，但TRH组的平均体重指数较高（TRH组为31.9，SRH组为25.8 kg/m²，p < 0.001）。与TRH组相比，接受SRH的女性复发脱垂≥II期的发生率更高（41.9%对20.0%，p = 0.03；OR 2.8，95% CI，1.07 - 7.7）。然而，当分析为复发≥处女膜水平时，两组之间没有差异（TRH组为12.5%，SRH组为18.6%，p = 0.45）。同样，当使用综合成功指标时，两组之间也没有差异（40例TRH中有30例[75%]，43例SRH中有29例[67.4%]成功，p = 0.45）。
与接受TRH的女性相比，接受SRH的女性在1年时复发脱垂≥II期的可能性高2.8倍，但使用综合评估分数时，两组之间没有差异
