Bergman Ida, Söderberg Marie Westergren, Kjaeldgaard Anders, Ek Marion
Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet and the Division of Obstetrics and Gynecology at Södersjukhuset, 11832 Södersjukhuset, Stockholm, Sweden.
Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden.
Int Urogynecol J. 2016 Sep;27(9):1357-65. doi: 10.1007/s00192-016-2981-0. Epub 2016 Mar 2.
The optimal suture material in traditional prolapse surgery is still controversial. Our aim was to investigate the effect of using sutures with rapid (RA) or slow (SA) absorption, on symptomatic recurrence after anterior and posterior colporrhaphy.
A population-based longitudinal cohort study with data from the Swedish National Quality Register for Gynecological Surgery. A total of 1,107 women who underwent primary anterior colporrhaphy and 577 women who underwent primary posterior colporrhaphy between September 2012 and September 2013 were included. Two groups in each cohort were created based on which suture material was used. Pre- and postoperative prolapse-related symptoms and patient satisfaction were assessed.
We found a significantly lower rate of symptomatic recurrence 1 year after anterior colporrhaphy in the SA suture group compared with the RA suture group, 50 out of 230 (22 %) vs 152 out of 501 (30 %), odds ratio 1.6 (CI 1.1-2.3; p = 0.01). The SA group also had a significantly higher patient satisfaction rate, 83 % vs 75 %, odds ratio 1.6 (CI 1.04-2.4), (p = 0.03). Urgency improved significantly more in the RA suture group (p < 0.001). In the posterior colporrhaphy cohort there was no significant difference between the suture materials.
This study indicates that the use of slowly absorbable sutures decreases the odds of having a symptomatic recurrence after an anterior colporrhaphy compared with the use of rapidly absorbable sutures. However, the use of RA sutures may result in less urgency 1 year postoperatively. In posterior colporrhaphy the choice of suture material does not affect postoperative symptoms.
传统脱垂手术中最佳缝合材料仍存在争议。我们的目的是研究使用快速吸收（RA）或缓慢吸收（SA）缝线对前后阴道壁修补术后症状复发的影响。
基于瑞典国家妇科手术质量登记处的数据进行一项基于人群的纵向队列研究。纳入了2012年9月至2013年9月期间接受初次前阴道壁修补术的1107名女性和接受初次后阴道壁修补术的577名女性。每个队列根据所使用的缝合材料分为两组。评估术前和术后与脱垂相关的症状及患者满意度。
我们发现，与RA缝线组相比，SA缝线组在前阴道壁修补术后1年症状复发率显著更低，230例中有50例（22%）复发，而501例中有152例（30%）复发，比值比为1.6（95%置信区间1.1 - 2.3；p = 0.01）。SA组患者满意度也显著更高，分别为83%和75%，比值比为1.6（95%置信区间1.04 - 2.4），（p = 0.03）。RA缝线组尿急症状改善更为显著（p < 0.001）。在后阴道壁修补术队列中，缝合材料之间无显著差异。
本研究表明，与使用快速吸收缝线相比，使用缓慢吸收缝线可降低前阴道壁修补术后症状复发的几率。然而，使用RA缝线可能导致术后1年尿急症状减轻。在后阴道壁修补术中，缝合材料的选择不影响术后症状。
