Seracchioli Renato, Raimondo Diego, Arena Alessandro, Gava Giulia, Parmeggiani Clara, Martelli Valentina, Moro Elisa, Zanello Margherita, Paradisi Roberto, Mabrouk Mohamed
Female Pelvic Med Reconstr Surg. 2018 Nov/Dec;24(6):399-403. doi: 10.1097/SPV.0000000000000464.
This study aimed to evaluate surgical and clinical outcomes of laparoscopic mesh-less cervicosacropexy for the treatment of uterovaginal prolapse.
This single institutional review board-approved prospective cohort study enrolled 46 consecutive, sexually active symptomatic women requiring surgical correction of uterovaginal prolapse, from July 2013 to March 2016. After supracervical laparoscopic hysterectomy, the cervix was suspended to the anterior longitudinal ligament of the sacral promontory through a continuous suture with plication and shortening of the right uterosacral ligament. Pelvic organs' function was evaluated through validated questionnaires during preoperative and postoperative follow-up evaluations. The anatomical recurrences of genital prolapse with a Pelvic Organ Prolapse Quantitative stage 2 or higher, in particular of central compartment (Pelvic Organ Prolapse Quantitative score C ≥-1), were recorded.
Mean ± SD age was 55.5 ± 10.9 years. Mean ± SD operating time was 97.4 ± 25.6 (range, 60-180) minutes. Mean ± SD hospitalization length was 3.6 ± 0.9 (range, 2-6) days. No intraoperative complications were recorded. Median length of follow-up was 24 (range, 12-38) months. During the follow-up period, the objective success rates for central compartment prolapse and for all compartments were 93.5% and 89.1%, respectively. No woman presented dyspareunia at follow-up. Thirty-nine women (84.8%) reported very high satisfaction related to surgery and 6 (13%) a moderate satisfaction. Overall Female Sexual Function Index, Knowles-Eccersley-Scott Symptom, and Bristol Female Lower Urinary Tract scores improved significantly after surgery, except for incontinence score domain.
Laparoscopic mesh-less cervicosacropexy represents an effective and feasible option for the surgical treatment of uterovaginal prolapse in sexually active women, avoiding postoperative complications due to the mesh use.
本研究旨在评估腹腔镜无网片宫颈骶骨固定术治疗子宫阴道脱垂的手术及临床效果。
本前瞻性队列研究经单一机构审查委员会批准，纳入了2013年7月至2016年3月期间46例连续的、有性生活且有症状的需要手术矫正子宫阴道脱垂的女性。在次全腹腔镜子宫切除术后，通过连续缝合将宫颈悬吊至骶岬前纵韧带，并对右侧子宫骶韧带进行折叠和缩短。在术前和术后随访评估中，通过经过验证的问卷对盆腔器官功能进行评估。记录盆腔器官脱垂定量分期为2期或更高，特别是中央隔（盆腔器官脱垂定量评分C≥-1）的生殖器脱垂的解剖学复发情况。
平均年龄±标准差为55.5±10.9岁。平均手术时间±标准差为97.4±25.6（范围60 - 180）分钟。平均住院时间±标准差为3.6±0.9（范围2 - 6）天。未记录到术中并发症。中位随访时间为24（范围12 - 38）个月。在随访期间，中央隔脱垂和所有隔的客观成功率分别为93.5%和89.1%。随访时无女性出现性交困难。39名女性（84.8%）报告对手术非常满意，6名（13%）报告中度满意。除尿失禁评分领域外，总体女性性功能指数、诺尔斯 - 埃克斯利 - 斯科特症状评分和布里斯托尔女性下尿路评分术后均显著改善。
腹腔镜无网片宫颈骶骨固定术是有性生活女性子宫阴道脱垂手术治疗的一种有效且可行的选择，可避免因使用网片导致的术后并发症。
