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[经盆底重建全盆底补片手术或骶棘韧带固定术治疗阴道脱垂的五年随访前瞻性研究结果]

[The results of five years follow-up prospective study of vaginal prolapse repaired by prolift total mesh surgery or sacrospinous fixation].

作者信息

Kraus P, Krofta L, Krčmář M, Urbánková I, Gojiš O, Grogregin K, Feyereisl J

出版信息

Ceska Gynekol. 2017 Fall;82(4):277-286.

Abstract

OBJECTIVE

The aim of the study is to compare the results of five years follow-up prospective study of vaginal prolapse repaired by prolift total mesh surgery or sacrospinous fixation.

STUDY DESIGN

A single-center prospective, cohort study, in patients with defect grade II and more by POP-Q.

SETTING

The Institute for the Care of Mather and Child; 3rd Medical Faculty Charles university, Prague.

METHODS

Comparison of the preoperative state and the five years after the operation according POP Q, ICIQ-SF, PISQ 12, VAS. Comparison of intraoperative and postoperative complications.

RESULTS

The study was attended by 142 patients; 75 patients underwent surgery Prolift Total and 67 patients sacrospinous fixation by Amreich Richter. On clinical examination at 5-year follow-up, we observed 15 (20.0%) case of anatomical failure in the Prolift group and 30 (44.8%) in the SSF group. Anatomic failure was defined clinically as Ba, C or Bp at the hymen or below. In assessing the overall condition before and five years after surgery using a VAS occurred in patients in the cohort Prolift Total decrease to 2.9 (± 1.9) from the original 7.8 (± 1.8). VAS in SSF group decreased after 5 years to 4.2 (± 2.7) of the original 7.8 (± 1.4). Values ICIQ-SF, analyzing the state of voiding PT group showed a decline from the original 6.7 (± 6.9) to 5.5 (± 5.3). A similar trend was evident even after the SSF. Parameters questionnaire PISQ-12 showed a positive increase from the original 28.6 (± 9.5) to 31.8 (± 7.9) points. PISQ-12 was improved from 28.7 (± 9.8) to 32.2 (± 7.5).

CONCLUSION

Recurrences were observed more frequently in patients after sacrospinous fixation, while the quality of life questionnaires yielded comparable postoperative results. Quantity of intraoperative complications is low and both groups do not differ.

摘要

目的

本研究旨在比较采用全盆底网片手术(Prolift)或骶棘韧带固定术治疗阴道脱垂的五年随访前瞻性研究结果。

研究设计

一项单中心前瞻性队列研究,研究对象为POP-Q分度II度及以上的患者。

研究地点

布拉格查理大学医学院第三附属医院母婴护理研究所。

方法

根据POP Q、ICIQ-SF、PISQ 12、VAS比较术前状态与术后五年的情况。比较术中及术后并发症。

结果

142例患者参与了本研究;75例行Prolift全盆底网片手术,67例行Amreich Richter骶棘韧带固定术。在5年随访的临床检查中,我们观察到Prolift组有15例(20.0%)出现解剖学失败,骶棘韧带固定术(SSF)组有30例(44.8%)。解剖学失败在临床上定义为处女膜或其下方的Ba、C或Bp。在使用VAS评估队列中Prolift全盆底网片手术患者术前及术后五年的总体状况时,从最初的7.8(±1.8)降至2.9(±1.9)。SSF组术后5年VAS从最初的7.8(±1.4)降至4.2(±2.7)。分析排尿状态的ICIQ-SF值显示,Prolift全盆底网片手术组从最初的6.7(±6.9)降至5.5(±5.3)。SSF术后也有类似趋势。PISQ-12问卷参数从最初的28.6(±9.5)分呈正向增加至31.8(±7.9)分。PISQ-12从28.7(±9.8)改善至32.2(±7.5)。

结论

骶棘韧带固定术后患者复发更常见,而生活质量问卷显示术后结果相当。术中并发症数量较少,两组无差异。

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