Nováčková M, Pastor Z, Brtnický T, Chmel R
Ceska Gynekol. 2017 Fall;82(5):383-389.
To determine the risk of prolapse recurrence in patients after vaginal hysterectomy with colporrhaphy.
Retrospective clinical study.
Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague.
The trial involved 220 women who underwent vaginal hysterectomy with anterior and posterior kolporrhaphy at our department for uterine prolapse at least grade 2. It was the first vaginal surgery in all of the patients. Subjective feeling of pressure in the vagina and/or palpable mass in the vagina or in front of the vaginal entrance and/or objective finding decline of the vaginal walls or fundus at lest the second degree or repeated surgery for prolapse were considered as a prolapse recurrence.
The mean age at the time of vaginal hysterectomy was 66.7 years (range 37-88). Only 11 patients were premenopausal (5%), the others were postmenopausal, a mean time of posmenopause was 16.9 years. The average parity rate of the study group was 2.1. The average duration of the surgery was 68 minutes. Postoperative urinary retention was observed in one patient (0.45%). 156 women were enrolled in the study. The average length of follow-up was 47 months (minimum 24 months). Recurrence of prolapse based on subjective assessment occured in 24 patients (15.4 %) with pressure and resistance in the vaginal introitus. According to objective criteria, the recurrence of prolapse was diagnosed in 33 (21.2%) patients, of which 16 had prolapse of the anterior vaginal wall, three of the posterior vaginal wall (two rectocoele, one rectoenterocoele), eight combination prolapse of anterior and posterior vaginal wall and vaginal vault prolapse was diagnosed in six women. Eight patients (5. 1%) underwent surgery because of prolapse recurrence. The mean interval from primary surgery to the time of reoperation was 24.4 months (range 6-62).
Patients have to be preoperatively informed about the risk of the prolapse recurrence with the recommendation of appropriate preventive arrangements.
确定行阴道子宫切除术加阴道修补术的患者发生脱垂复发的风险。
回顾性临床研究。
布拉格查理大学第二医学院妇产科及莫托尔大学医院。
该试验纳入了220例在我院因子宫脱垂至少2级而行阴道子宫切除术加前后阴道修补术的女性患者。所有患者均为首次行阴道手术。阴道内有压迫感和/或可触及阴道内或阴道口前方有肿物，和/或客观检查发现阴道壁或阴道穹窿至少二度下降或因脱垂再次手术，均被视为脱垂复发。
阴道子宫切除术时的平均年龄为66.7岁（范围37 - 88岁）。仅11例患者为绝经前（5%），其他患者为绝经后，平均绝经时间为16.9年。研究组的平均产次为2.1次。平均手术时长为68分钟。1例患者（0.45%）出现术后尿潴留。156名女性纳入研究。平均随访时长为47个月（最短24个月）。根据主观评估，24例患者（15.4%）出现脱垂复发，表现为阴道口有压迫感和阻力。根据客观标准，33例（21.2%）患者被诊断为脱垂复发，其中16例为阴道前壁脱垂，3例为阴道后壁脱垂（2例直肠膨出，1例直肠小肠膨出），8例为阴道前后壁联合脱垂，6例女性被诊断为阴道穹窿脱垂。8例患者（5.1%）因脱垂复发接受手术。从初次手术到再次手术的平均间隔时间为24.4个月（范围6 - 62个月）。
术前必须告知患者脱垂复发的风险，并建议采取适当的预防措施。
