Lo Tsia-Shu, Jaili Sukanda, Uy-Patrimonio Ma Clarissa, Karim Nazura Bt, Ibrahim Rami
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung, Medical Center, Keelung, Taiwan.
Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.
J Obstet Gynaecol Res. 2017 Mar;43(3):543-550. doi: 10.1111/jog.13234. Epub 2017 Feb 4.
The aim of this study was to evaluate the management outcomes of advanced pelvic organ prolapse (POP) in nulliparous women.
Eight nulliparous women diagnosed with POP ≥ stage 3 between January 2005 and August 2013, according to the Pelvic Organ Quantification System (POPQ), were reviewed. Seven were managed surgically and one was managed with pessary. Primary outcome was surgical objective cure (POP-Q ≤ 1) and subjective cure, defined as negative response to questions 2 and 3 on Pelvic Organ Prolapse Distress Inventory 6. Secondary outcomes were complications, symptoms' severity and quality of life according to validated questionnaires.
A total of 1275 prolapse patients with POP-Q ≥ stage 3 were managed surgically, among whom seven (0.55%) were nulliparous. Each woman had at least one risk factor associated with POP. Risk factors identified were history of pelvic trauma, obesity, menopause, chronic cough, hard physical labor and constipation. Five patients underwent surgical correction (vaginal hysterectomy with sacrospinous fixation) with mesh (Perigee, n = 3; Avaulta, n = 2). Two patients had uterine preservation without mesh (hysteropexy with sacrospinous ligament fixation). One patient preferred treatment with pessary. The total cure rate (objective and subjective cure rates) was 86% after surgical reconstructive surgery.
Management of nulliparous advanced POP poses significant challenges with regard to uterine preservation, future pregnancy and childbirth. Conservative management with pessary insertion should be offered followed by surgical correction. Reconstructive surgery with mesh may improve prolapse symptoms objectively and subjectively.
本研究旨在评估未生育女性晚期盆腔器官脱垂（POP）的治疗效果。
回顾性分析2005年1月至2013年8月期间，根据盆腔器官定量系统（POPQ）诊断为POP≥3期的8例未生育女性。7例行手术治疗，1例行子宫托治疗。主要结局指标为手术客观治愈（POP-Q≤1）和主观治愈，主观治愈定义为盆腔器官脱垂困扰量表6中问题2和问题3的回答为阴性。次要结局指标为根据有效问卷得出的并发症、症状严重程度和生活质量。
共有1275例POP-Q≥3期的脱垂患者接受了手术治疗，其中7例（0.55%）为未生育女性。每位女性至少有一项与POP相关的危险因素。确定的危险因素包括盆腔创伤史、肥胖、绝经、慢性咳嗽、重体力劳动和便秘。5例患者接受了带网片的手术矫正（经阴道子宫切除术加骶棘肌固定术）（Perigee网片，n = 3；Avaulta网片，n = 2）。2例患者保留子宫未使用网片（子宫骶棘韧带固定术）。1例患者选择子宫托治疗。手术重建后的总治愈率（客观治愈率和主观治愈率）为86%。
未生育女性晚期POP的治疗在子宫保留、未来妊娠和分娩方面面临重大挑战。应先提供子宫托保守治疗，然后再进行手术矫正。使用网片的重建手术可在客观和主观上改善脱垂症状。
