Lo Tsia-Shu, Uy-Patrimonio Ma Clarissa, Hsieh Wu-Chiao, Yang Ju-Chun, Huang Shih Yin, Chua Sandy
Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Keelung Medical Center, 222, Maijin Road, Keelung, 204, Taiwan, Republic of China.
Division of Urogynaecology, Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China.
Int Urogynecol J. 2018 Jun;29(6):811-819. doi: 10.1007/s00192-017-3487-0. Epub 2017 Oct 2.
Uterine preservation in uterine prolapse is an option for young patients. We hypothesized that sacrospinous hysteropexy (SSH) with anchorage to both the anterior and posterior cervix (SSH-ap) would have a better outcome than SSH with anchorage to the posterior cervix only (SSH-p).
This was a retrospective study including 75 patients who underwent SSH at Chang Gung Memorial Hospital between March 2008 and August 2013. Five were excluded due to incomplete data. Of the remaining 70 patients, 35 underwent SSH-p between March 2008 and June 2011, and 35 underwent SSH-ap between June 2010 and August 2013. The primary outcome was the objective anatomical result, and a successful outcome was considered anatomical correction (POP-Q stage 1 or less) of anterior and apical prolapse. Subjective outcome was evaluated using the POPDI-6 questionnaire, and a patient response of "No or mild abdominal organ falling out sensation" together with "No or mild heaviness" was considered to indicate a successful outcome. Anterior fornix and cervical diameter measurements were included. The secondary outcome was quality of life according to the UDI-6, IIQ-7, POPDI-6, and PISQ-12 questionnaires. The 3-year outcome was used for comparison.
The subjective overall cure rates were significantly different between the SSH-p and SSH-ap groups (74.3% and 94.3%, respectively; p = 0.023). However, the objective overall cure rates were not significantly different (74.3% and 82.9%, respectively).
Anchorage of the anterior cervix and vaginal wall together with the usual posterior anchorage yield better subjective outcomes and apical suspension at 3 years after surgery than anchorage of the posterior cervix and vaginal wall only. The cervix position affected the subjective outcome. Concurrent trachelectomy did not affect the outcome.
对于年轻患者，子宫脱垂时保留子宫是一种选择。我们假设，同时对子宫颈前后部进行骶棘韧带子宫固定术（SSH-ap）比仅对子宫颈后部进行骶棘韧带子宫固定术（SSH-p）效果更好。
这是一项回顾性研究，纳入了2008年3月至2013年8月在长庚纪念医院接受SSH手术的75例患者。5例因数据不完整被排除。其余70例患者中，35例在2008年3月至2011年6月接受了SSH-p手术，35例在2010年6月至2013年8月接受了SSH-ap手术。主要结局是客观解剖结果，成功结局定义为前位和顶端脱垂的解剖学矫正（盆腔器官脱垂定量分期系统[POP-Q] 1期或更低）。使用盆腔器官脱垂/尿失禁功能障碍指数-6（POPDI-6）问卷评估主观结局，患者回答“无或仅有轻度腹部脏器脱出感”以及“无或仅有轻度坠胀感”被视为成功结局。测量前穹窿和宫颈直径。次要结局是根据盆底功能障碍影响问卷-6（UDI-6）、下尿路症状问卷-7（IIQ-7）、POPDI-6和盆底功能障碍性生活质量问卷-12（PISQ-12）评估的生活质量。采用3年结局进行比较。
SSH-p组和SSH-ap组的主观总体治愈率有显著差异（分别为74.3%和94.3%；p = 0.023）。然而，客观总体治愈率无显著差异（分别为74.3%和82.9%）。
与仅对子宫颈后部和阴道壁进行固定相比，同时对子宫颈前部和阴道壁进行固定，并结合常规的后部固定，在术后3年可产生更好的主观结局和顶端悬吊效果。宫颈位置影响主观结局。同时进行宫颈切除术不影响结局。
