Carter-Brooks Charelle M, Lowder Jerry L, Du Angela L, Lavelle Erin S, Giugale Lauren E, Shepherd Jonathan P
Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO.
University of Pittsburgh, School of Medicine, Pittsburgh, PA.
Female Pelvic Med Reconstr Surg. 2019 May/Jun;25(3):226-230. doi: 10.1097/SPV.0000000000000528.
The aim of the study was to evaluate postoperative genital hiatus after apical suspension procedures without a level 3 support procedure (L3SP), posterior repair, and perineorrhaphy, compared with normative-value genital hiatus of 3.4 cm.
This an analysis of a pre-existing retrospectively collected database that included all minimally invasive sacrocolpopexies and uterosacral ligament suspensions performed at a tertiary medical center from January 2009 to August 2015.
We identified 1006 surgical cases: 160 (15.9%) apical suspensions with L3SPs and 846 (84.1%) without. Mean (SD) age was 59 (9) years and body mass index was 27.6 (4.7) kg/m. Women were mainly white (97.4%) with stage III prolapse (67.8%). Those who underwent L3SPs were more likely to be premenopausal and undergo hysterectomy and USLS.Baseline genital hiatus was similar with and without L3SPs (4.8 [1.2] cm vs 4.6 [1.1] cm, P = 0.096). Postoperative genital hiatus was reduced beyond normative (3.4 cm) after apical suspension without (3.0 [0.7] cm, P < 0.001) and with (2.8 [0.9] cm, P < 0.001) L3SPs. Postoperative genital hiatus after L3SPs was similar to those without (2.8 [0.9] cm vs 3.0 [0.7] cm, P = 0.06). We found that change in genital hiatus was greater, by 0.7 cm, when L3SP was performed versus not performed (2.3 [1.2] cm vs 1.6 [1.1] cm, P < 0.001).
Level 3 support procedures may be unnecessary to restore genital hiatus to normal at time of apical suspension procedures and should be reserved for select patients.
本研究旨在评估在未进行三级支持手术（L3SP）、后位修复及会阴缝合的顶端悬吊手术后的术后生殖裂孔情况，并与3.4厘米的正常生殖裂孔值进行比较。
这是一项对预先存在的回顾性收集数据库的分析，该数据库包含了2009年1月至2015年8月在一家三级医疗中心进行的所有微创骶棘韧带固定术和子宫骶骨韧带悬吊术。
我们确定了1006例手术病例：160例（15.9%）进行了L3SP的顶端悬吊术，846例（84.1%）未进行。平均（标准差）年龄为59（9）岁，体重指数为27.6（4.7）千克/平方米。女性主要为白人（97.4%），处于III期脱垂（67.8%）。接受L3SP的患者更可能处于绝经前，且接受子宫切除术和子宫骶骨韧带悬吊术。有无L3SP时的基线生殖裂孔相似（4.8[1.2]厘米对4.6[1.1]厘米，P = 0.096）。在未进行（3.0[0.7]厘米，P < 0.001）和进行（2.8[0.9]厘米，P < 0.001）L3SP的顶端悬吊术后，术后生殖裂孔均缩小至低于正常范围（3.4厘米）。L3SP术后的生殖裂孔与未进行L3SP的相似（2.8[0.9]厘米对3.0[0.7]厘米，P = 0.06）。我们发现，进行L3SP时生殖裂孔的变化比未进行时大0.7厘米（2.3[1.2]厘米对1.6[1.1]厘米，P < 0.001）。
在顶端悬吊手术时，三级支持手术可能并非恢复生殖裂孔正常所必需，应仅用于特定患者。
