Ridgeway Beri M
Center of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH.
Am J Obstet Gynecol. 2015 Dec;213(6):802-9. doi: 10.1016/j.ajog.2015.07.035. Epub 2015 Jul 28.
Hysterectomy has historically been a mainstay in the surgical treatment of uterovaginal prolapse, even in cases in which the removal of the uterus is not indicated. However, uterine-sparing procedures have a long history and are now becoming more popular. Whereas research on these operations is underway, hysteropexy for the treatment of prolapse is not as well studied as hysterectomy-based repairs. Compared with hysterectomy and prolapse repair, hysteropexy is associated with a shorter operative time, less blood loss, and a faster return to work. Other advantages include maintenance of fertility, natural timing of menopause, and patient preference. Disadvantages include the lack of long-term prolapse repair outcomes and the need to continue surveillance for gynecological cancers. Although the rate of unanticipated abnormal pathology in this population is low, women who have uterine abnormalities or postmenopausal bleeding are not good candidates for uterine-sparing procedures. The most studied approaches to hysteropexy are the vaginal sacrospinous ligament hysteropexy and the abdominal sacrohysteropexy, which have similar objective and subjective prolapse outcomes compared with hysterectomy and apical suspension. Pregnancy and delivery have been documented after vaginal and abdominal hysteropexy approaches, although very little is known about outcomes following parturition. Uterine-sparing procedures require more research but remain an acceptable option for most patients with uterovaginal prolapse after a balanced and unbiased discussion reviewing the advantages and disadvantages of this approach.
从历史上看，子宫切除术一直是子宫阴道脱垂外科治疗的主要手段，即使在子宫切除并无指征的情况下也是如此。然而，保留子宫的手术已有很长历史，且如今越来越受欢迎。尽管针对这些手术的研究正在进行，但用于治疗脱垂的子宫固定术的研究不如基于子宫切除术的修复术充分。与子宫切除术和脱垂修复术相比，子宫固定术的手术时间更短、失血更少，且恢复工作更快。其他优点包括保留生育能力、自然绝经时间以及患者偏好。缺点包括缺乏长期脱垂修复效果，以及需要继续监测妇科癌症。尽管该人群中意外异常病理的发生率较低，但有子宫异常或绝经后出血的女性并非保留子宫手术的合适人选。研究最多的子宫固定术方法是阴道骶棘韧带子宫固定术和腹骶子宫固定术，与子宫切除术和顶端悬吊术相比，它们在客观和主观脱垂结果方面相似。阴道和腹部子宫固定术方法后已有妊娠和分娩的记录，尽管对分娩后的结果了解甚少。保留子宫的手术需要更多研究，但在对该方法的优缺点进行平衡且无偏见的讨论后，对大多数子宫阴道脱垂患者来说仍是一个可接受的选择。
