Department of Obstetrics & Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
Ultrasound Obstet Gynecol. 2017 Dec;50(6):776-780. doi: 10.1002/uog.17407. Epub 2017 Nov 9.
The aim of this study was to investigate whether the presence of levator ani muscle (LAM) avulsion is associated with expulsion within 1 year of a vaginal pessary placed for pelvic organ prolapse (POP).
This was a prospective observational study of consecutive women with symptomatic POP, who had not received treatment for the condition before the consultation and opted for vaginal pessary placement in our center. Volume acquisition was performed before pessary insertion and offline analysis of the 3D/4D transperineal ultrasound volume data was performed. LAM was assessed on maximum pelvic floor muscle contraction (PFMC) and hiatal dimensions were assessed at rest, on PFMC and on maximum Valsalva. Results were compared between women in whom the pessary was retained for 1 year and those in whom the pessary was expelled within 1 year.
The datasets of 255 women were analyzed including 147 (57.6%) women who had a vaginal pessary continuously in place over 1 year and 108 (42.4%) with pessary expulsion. Mean age was 63.2 (SD, 9.9) years and median parity was 3 (2-4). Eighteen (7.1%) had Stage I, 164 (64.3%) Stage II, 67 (26.3%) Stage III and six (2.4%) Stage IV POP. Women with vaginal pessary expulsion within 1 year had significantly larger hiatal dimensions at rest and on Valsalva, larger hiatal area during rest, PFMC and Valsalva and higher rate of LAM avulsion (53.7% vs 27.2%, P < 0.01) compared with women in whom the pessary was retained for 1 year. After controlling for potential confounders, LAM avulsion remained a risk factor (OR, 3.18, P < 0.01) of vaginal pessary expulsion within 1 year.
Women in whom a vaginal pessary was expelled within 1 year of placement for POP had a larger hiatus. Presence of LAM avulsion was associated with a three-fold increase in the risk of expulsion of a vaginal pessary within 1 year. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
本研究旨在探讨肛提肌撕裂（LAM）是否与阴道子宫托治疗盆腔器官脱垂（POP）后 1 年内脱垂复发相关。
这是一项针对有症状的 POP 患者的前瞻性观察性研究，这些患者在就诊前未接受过任何治疗，选择在我们中心放置阴道子宫托。在放置子宫托前进行容积采集，然后离线分析 3D/4D 经会阴超声容积数据。在最大盆底肌肉收缩时评估肛提肌，在休息时、最大盆底肌肉收缩时和最大valsalva 时评估裂孔尺寸。比较子宫托放置 1 年以上和 1 年内脱落的两组患者的结果。
共分析了 255 名女性的数据集，其中 147 名（57.6%）女性的阴道子宫托连续放置 1 年以上，108 名（42.4%）子宫托脱落。平均年龄为 63.2（SD，9.9）岁，中位产次为 3（2-4）次。18 名（7.1%）患者为Ⅰ期，164 名（64.3%）为Ⅱ期，67 名（26.3%）为Ⅲ期，6 名（2.4%）为Ⅳ期 POP。与放置 1 年以上的女性相比，1 年内阴道子宫托脱落的女性在休息和valsalva 时裂孔尺寸明显更大，在休息、最大盆底肌肉收缩和 valsalva 时裂孔面积更大，肛提肌撕裂的发生率更高（53.7%比 27.2%，P<0.01）。在控制潜在混杂因素后，肛提肌撕裂仍然是 1 年内阴道子宫托脱落的危险因素（OR，3.18，P<0.01）。
POP 患者在放置阴道子宫托后 1 年内脱落，裂孔更大。肛提肌撕裂的存在与 1 年内阴道子宫托脱落的风险增加三倍相关。版权所有 © 2017 ISUOG。由 John Wiley & Sons Ltd 出版。
