Richter Lee A, Park Amy J, Boileau Jenine E, Janni Megan, Desale Sameer, Iglesia Cheryl B
From the *National Center for Advanced Pelvic Surgery, MedStarWashington Hospital Center; †Departments of Obstetrics and Gynecology and Urology, ‡Georgetown University School of Medicine; and §Department of Biostatistics and Epidemiology, MedStar Health Research Institute, Washington, DC.
Female Pelvic Med Reconstr Surg. 2016 May-Jun;22(3):146-50. doi: 10.1097/SPV.0000000000000245.
The best predictors for postoperative anatomic apical success after transvaginal uterosacral ligament suspension remain unknown. The aim of this study was to determine if there is a correlation between the preoperative D point and anatomic outcomes for apical prolapse after 1 year.
This retrospective cohort study included subjects undergoing transvaginal uterosacral ligament suspension from 2008 through 2013 who had at least 1 year follow-up. Demographic information, preoperative and postoperative Pelvic Organ Prolapse Quantification (POPQ) examination measurements, need for retreatment or repeat surgery, and assessment of pelvic floor symptoms were reviewed. Postoperative apical success was defined as C point descent no more than one third into the vaginal canal.
One hundred twenty-five women met inclusion criteria and had follow-up at 1 year or more. Concomitant procedures included anterior/posterior repair and midurethral sling. Mean follow-up time was 22.8 months (range, 12-63 months). At last follow-up, 96% met criteria for apical success. A more negative preoperative D point was significantly related to improved postoperative apical support, with each 1-cm descent in preoperative D point resulting in a postoperative C point that was 0.21 cm lower (P = 0.0005). Based on the receiver operating characteristic curve, a "cutoff" D point value of -4.25 (sensitivity, 0.8; specificity, 0.65) was determined to be a predictor of postoperative apical success at 1 year or more.
The preoperative D point correlates with postoperative apical support, and a clinically meaningful relationship exists between the preoperative D point and anatomic apical success.
经阴道子宫骶韧带悬吊术后解剖学上的顶端成功的最佳预测因素仍不明确。本研究的目的是确定术前D点与1年后顶端脱垂的解剖学结局之间是否存在相关性。
这项回顾性队列研究纳入了2008年至2013年接受经阴道子宫骶韧带悬吊术且至少随访1年的受试者。回顾了人口统计学信息、术前和术后盆底器官脱垂定量（POPQ）检查测量结果、再次治疗或再次手术的需求以及盆底症状评估。术后顶端成功定义为C点下降不超过阴道管的三分之一。
125名女性符合纳入标准并进行了1年或更长时间的随访。同期手术包括前后壁修补和尿道中段吊带术。平均随访时间为22.8个月（范围12 - 63个月）。在最后一次随访时，96%的患者达到顶端成功标准。术前D点越负与术后顶端支持改善显著相关，术前D点每下降1 cm，术后C点降低0.21 cm（P = 0.0005）。根据受试者工作特征曲线，确定“临界”D点值为 -4.25（敏感性0.8；特异性0.65）可作为1年或更长时间术后顶端成功的预测指标。
术前D点与术后顶端支持相关，术前D点与解剖学上的顶端成功之间存在具有临床意义的关系。
