, Washington, USA.
Curr Urol Rep. 2018 Feb 23;19(2):15. doi: 10.1007/s11934-018-0765-4.
Women have an estimated 12.6% lifetime risk of undergoing surgery for pelvic organ prolapse in the USA (Wu et al. in Obstet Gynecol 123(6): 1201-6, 2014). Surgical repair of uterovaginal prolapse most commonly includes hysterectomy and vaginal vault suspension; however, the value of concomitant hysterectomy is uncertain, and there appears to be growing interest in uterine conservation. Multiple procedures have evolved using a variety of approaches. The aim of this paper is to review uterine sparing (hysteropexy) prolapse repair techniques and outcomes.
Several randomized controlled trials (RCT) have shown comparable success rates for apical compartment support with sacrospinous hysteropexy as compared to vaginal hysterectomy with uterosacral ligament suspension, with shorter hospitalization and quicker return to work. (Detollenaere et al. in BMJ 351: h3717, 2015); (Dietz et al. in Int Urogynecol J Pelvic Floor Dysfunct 21(2): 209-16, 2010). Available data suggest vaginal mesh hysteropexy is as effective as vaginal mesh with hysterectomy, with lower rates of mesh exposure. (Maher et al., 2017) To date, no RCTs have been published comparing sacral hysteropexy to hysterectomy with sacral colpopexy. Overall, there is a higher reoperation rate for sacral hysteropexy and a higher mesh exposure rate for hysterectomy with sacral colpopexy. (Maher et al., 2017) No RCTs have been published comparing hysteropexy surgical approaches. Although hysteropexy data is expanding, there is a need for more information regarding long-term surgical durability, appropriate patient selection, and whether one approach is superior to another.
据估计，美国女性一生中因盆腔器官脱垂而接受手术的风险约为 12.6%（Wu 等人，在 Obstet Gynecol 123（6）：1201-6，2014）。阴道子宫脱垂的手术修复最常包括子宫切除术和阴道穹窿悬吊术；然而，同时进行子宫切除术的价值尚不确定，并且对子宫保留的兴趣似乎在不断增加。已经开发了多种使用各种方法的手术。本文的目的是回顾保留子宫（子宫固定术）脱垂修复技术和结果。
几项随机对照试验（RCT）表明，骶骨固定术治疗穹窿顶支撑的成功率与阴道子宫切除术联合子宫骶骨韧带悬吊术相当，住院时间更短，工作恢复更快（Detollenaere 等人，在 BMJ 351：h3717，2015）；（Dietz 等人，在 Int Urogynecol J Pelvic Floor Dysfunct 21（2）：209-16，2010）。现有数据表明，阴道网片子宫固定术与阴道网片联合子宫切除术同样有效，网片暴露率较低。（Maher 等人，2017 年）迄今为止，尚未发表比较骶骨固定术与子宫切除术联合骶骨阴道固定术的 RCT。总体而言，骶骨固定术的再手术率较高，子宫切除术联合骶骨阴道固定术的网片暴露率较高。（Maher 等人，2017 年）尚未发表比较子宫固定术手术方法的 RCT。尽管子宫固定术数据不断增加，但仍需要更多关于长期手术耐久性、适当的患者选择以及一种方法是否优于另一种方法的信息。
