Nager Charles W, Grimes Cara L, Nolen Tracy L, Wai Clifford Y, Brubaker Linda, Jeppson Peter C, Wilson Tracey S, Visco Anthony G, Barber Matthew D, Sutkin Gary, Norton Peggy, Rardin Charles R, Arya Lily, Wallace Dennis, Meikle Susan F
Department of Obstetrics and Gynecology, Westchester Medical Center, New York, NY.
Research Triangle International, Research Triangle Park, NC.
Female Pelvic Med Reconstr Surg. 2019 Jan/Feb;25(1):22-28. doi: 10.1097/SPV.0000000000000526.
The aim of the study was to compare anterior and overall prolapse prevalence at 1 year in surgical participants with or without concomitant anterior repair (AR) at the time of sacrospinous ligament fixation (SSLF) or uterosacral ligament suspension (ULS).
This is a secondary analysis of two surgical trials; concomitant AR was performed at surgeon's discretion. Anterior anatomic success was defined as pelvic organ prolapse quantification of prolapse point Ba ≤0 and overall success was defined as pelvic organ prolapse quantification points Ba, Bp, and C ≤0 at 12 months.
Sixty-three percent (441/701) of the participants underwent concomitant AR and were older, more often postmenopausal, had previous hysterectomy, and had higher-stage anterior, but not apical prolapse. Anterior anatomic success was marginally but statistically better in the combined group (SSLF and ULS) with concomitant AR (82% vs 80%, P = 0.03). In subanalyses, the improvement in anatomic support with AR was observed only in the SSLF subgroup (81% vs 73%, P = 0.02) and mostly in the SSLF subgroup with higher preoperative stage (74% vs 57%, P = 0.02). Anterior repair did not improve success rates in participants with lower-stage prolapse or undergoing ULS. Overall success rates were similar to anterior anatomic success rates. Participants with higher-stage preoperative anterior prolapse had significantly lower success rates.
In the absence of clinical trial data, this analysis suggests an AR should be considered for women with higher-stage prolapse undergoing an SSLF. Preoperative prolapse severity is a strong predictor of poor anatomic outcomes with native tissue vaginal apical surgeries.
本研究旨在比较在骶棘韧带固定术（SSLF）或子宫骶骨韧带悬吊术（ULS）时接受或未接受同期前路修复（AR）的手术参与者1年时的前壁脱垂患病率和总体脱垂患病率。
这是对两项手术试验的二次分析；同期AR由外科医生自行决定是否进行。前路解剖学成功定义为盆腔器官脱垂定量中脱垂点Ba≤0，总体成功定义为12个月时盆腔器官脱垂定量点Ba、Bp和C≤0。
63%（441/701）的参与者接受了同期AR，这些参与者年龄更大，绝经后女性更常见，既往有子宫切除术，且前壁脱垂分期更高，但顶端脱垂分期不高。在接受同期AR的联合组（SSLF和ULS）中，前路解剖学成功率略高但具有统计学意义（82%对80%，P = 0.03）。在亚组分析中，仅在SSLF亚组中观察到AR对解剖学支撑的改善（81%对73%，P = 0.02），且主要在术前分期较高的SSLF亚组中（74%对57%，P = 0.02）。前路修复并未提高脱垂分期较低或接受ULS的参与者的成功率。总体成功率与前路解剖学成功率相似。术前前壁脱垂分期较高的参与者成功率显著较低。
在缺乏临床试验数据的情况下，本分析表明，对于接受SSLF的脱垂分期较高的女性应考虑进行AR。术前脱垂严重程度是天然组织阴道顶端手术解剖学结果不佳的有力预测因素。
