Vieillefosse Sarah, Thubert Thibault, Dache Arnaud, Hermieu Jean-François, Deffieux Xavier
AP-HP, Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Antoine Béclère, Clamart 92141, France.
Clinique urologique, hôpital Bichat, AP-HP, 75018 Paris, France.
Eur J Obstet Gynecol Reprod Biol. 2015 Apr;187:51-6. doi: 10.1016/j.ejogrb.2015.02.014. Epub 2015 Feb 18.
To compare the operative results and rate of complications, in particular dorsolumbar pain, following laparoscopic sacrocolpopexy (LS) using sutures or tackers.
A case-control study: LS using tackers (n=35, tacker group) compared with LS using sutures (n=65, suture group). In addition to clinical evaluation of prolapse, all patients were evaluated for urinary incontinence (ICIQ-SF), dorsolumbar pain, overall quality of life (SF-36 score), and overall improvement in symptoms (PGI-I), one year after LS.
The patient characteristics (age, initial stage of prolapse,…) were comparable in the two groups, as was operating time (240 vs. 210min, p=0.18). There was no significant between-group difference in terms of anatomical correction (median post-operative ICS stage: 0 in both groups, p=0.26) or post-operative complication rates. The incidence of de novo low back pain appearing after LS was equivalent in both groups (50% vs. 25%, in the tacker and suture groups, respectively, p=0.11). However, there was a significant difference in lumbar pain intensity evaluated using the visual analog scale (4 (IQR 0-6.5) vs. 0 (IQR 0-4) in the tacker and suture groups, respectively; p=0.01), and in post-operative quality of life, which was better in patients in the suture group according to all the questionnaires.
Our study suggests that the use of tackers for prosthesis fixation to the promontory does not increase the incidence of post-operative dorsolumbar pain, but may increase its intensity and decrease quality of life.
比较使用缝线或钉合器进行腹腔镜骶骨阴道固定术（LS）后的手术效果和并发症发生率，尤其是腰背部疼痛的发生率。
一项病例对照研究：使用钉合器的LS（n = 35，钉合器组）与使用缝线的LS（n = 65，缝线组）进行比较。除了对脱垂进行临床评估外，所有患者在LS术后一年均接受尿失禁（ICIQ - SF）、腰背部疼痛、总体生活质量（SF - 36评分）以及症状总体改善情况（PGI - I）的评估。
两组患者的特征（年龄、脱垂初始阶段等）以及手术时间（240分钟对210分钟，p = 0.18）具有可比性。在解剖学矫正方面（术后中位ICS分期：两组均为0期，p = 0.26）或术后并发症发生率方面，两组之间无显著差异。LS术后新发下腰痛的发生率在两组中相当（钉合器组和缝线组分别为50%和25%，p = 0.11）。然而，使用视觉模拟量表评估的腰痛强度存在显著差异（钉合器组和缝线组分别为4（四分位间距0 - 6.5）和0（四分位间距0 - 4）；p = 0.01），并且术后生活质量也存在显著差异，根据所有问卷，缝线组患者的生活质量更好。
我们的研究表明，使用钉合器将假体固定至岬部不会增加术后腰背部疼痛的发生率，但可能会增加其强度并降低生活质量。
