Geoffrion Roxana, Hyakutake Momoe T, Koenig Nicole A, Lee Terry, Cundiff Geoffrey W
Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC.
J Obstet Gynaecol Can. 2015 Feb;37(2):129-137. doi: 10.1016/S1701-2163(15)30334-0.
Bilateral sacrospinous fixation with tailored mesh arms (bSSVF) uses polypropylene mesh to suspend the vault to the sacrospinous ligaments bilaterally with minimal tension, recreating nulliparous midline anatomy. It can be used with uterine conservation. Our primary objective was to determine objective cure rate at one year following bSSVF compared with a control group undergoing abdominal sacrocolpopexy (ASC). Secondary objectives were to compare symptoms, quality of life, sexual function, pain, and global satisfaction before and after surgery and between bSSVF and ASC groups at one year.
This prospective cohort study enrolled patients with symptomatic prolapse who chose to undergo bSSVF or ASC. Baseline demographics were obtained. Prolapse quantification, validated symptom questionnaire scores, and McGill pain scores were obtained at baseline, six weeks, and one-year postoperatively. Global satisfaction was recorded. The primary outcome measure was the difference in cure rate (vault stage ≤ 1) between groups.
Fifty patients were recruited: 30 underwent bSSVF and 17 ASC. Forty-three patients were available for one-year follow-up. Baseline data were similar. There was no difference in vault stage between bSSVF and ASC groups at one year. Five women who underwent bSSVF had cervical elongation, and four of these were classified as POP recurrence. Women who underwent bSSVF had more anterior recurrences but fewer postoperative complications, shorter hospital stay, and less use of narcotics than controls. Questionnaire scores were similar at one year. All respondents felt subjective improvement after either surgical procedure.
Objective and subjective cure rates are comparable after bSSVF and ASC. Hysteropexy may cause cervical elongation that merits further research.
采用定制网片臂的双侧骶棘肌固定术（bSSVF）使用聚丙烯网片将穹隆双侧悬吊于骶棘韧带上，张力最小，重建未生育女性的中线解剖结构。该手术可用于保留子宫的情况。我们的主要目的是确定bSSVF术后一年与接受腹骶阴道固定术（ASC）的对照组相比的客观治愈率。次要目的是比较手术前后以及bSSVF组和ASC组术后一年的症状、生活质量、性功能、疼痛和总体满意度。
这项前瞻性队列研究纳入了有症状脱垂且选择接受bSSVF或ASC的患者。获取了基线人口统计学数据。在基线、术后六周和一年时进行脱垂量化、经过验证的症状问卷评分和麦吉尔疼痛评分。记录总体满意度。主要结局指标是两组之间治愈率（穹隆分期≤1）的差异。
招募了50名患者：30例行bSSVF，17例行ASC。43名患者可进行一年的随访。基线数据相似。bSSVF组和ASC组术后一年穹隆分期无差异。5例行bSSVF的女性出现宫颈延长，其中4例被归类为盆腔器官脱垂复发。与对照组相比，行bSSVF的女性前位复发更多，但术后并发症更少、住院时间更短且使用麻醉剂更少。一年时问卷评分相似。所有受访者在任何一种手术后都感觉主观上有改善。
bSSVF和ASC术后的客观和主观治愈率相当。子宫固定术可能导致宫颈延长，值得进一步研究。
