Schiavi Michele Carlo, Savone Delia, Di Mascio Daniele, Di Tucci Chiara, Perniola Giorgia, Zullo Marzio Angelo, Muzii Ludovico, Benedetti Panici Pierluigi
Department of Gynecological and Obstetric Sciences, and Urological Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy.
Department of Gynecological and Obstetric Sciences, and Urological Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy.
Eur J Obstet Gynecol Reprod Biol. 2018 Apr;223:113-118. doi: 10.1016/j.ejogrb.2018.02.025. Epub 2018 Feb 27.
The aim of this study was to evaluate the effectiveness of modified McCall culdoplasty or Shull suspension in preventing vaginal vault prolapse after vaginal hysterectomy and the long-term impact on quality of life and sexual function.
Retrospective analysis in 414 patients underwent vaginal hysterectomy for pelvic organ prolapse (POP) and vaginal suspension through modified McCall culdoplasty (group A) or Shull suspension (group B) was evaluated. Clinical features and concomitant surgical procedures were assessed. Surgical data and perioperative and postoperative complications have also been analyzed. Clinical characteristics, urinary symptoms, POP-Q score classification, Quality of Life and Sexual Function were evaluated at baseline and at median follow up with P-QoL, ICIQ-UI-SF, PISQ-12, FSFI, FSDS questionnaires.
The median follow up was 8.9 year (5.1-14.2 years). 200 women in group A and 214 in group B were evaluated. Vaginal vault prolapse occurred in 2 patients in group A and in 2 patients in group B. POP-Q score for all compartments showed a significant (p < 0.001) decrease for both groups without significant differences between the 2 groups. The total vaginal length (TVL) was reduced in greater proportion in McCall group (p < 0.001). P-QoL and ICIQ-UI-SF questionnaires documented an improvement for both groups (p < 0.001). The number of patients who regularly practice sexual activity increased in both groups, but patients in group B experienced a better quality of sexual life evaluated with PISQ-12 and FSFI.
Both surgical techniques showed effectiveness and safety in preventing vaginal vault prolapse in women who underwent vaginal hysterectomy, with a significant improvement in quality of life and sexuality. Shull technique demonstrated greater improvement in sexual function.
本研究旨在评估改良麦考尔直肠阴道固定术或舒尔悬吊术在预防阴道子宫切除术后阴道穹窿脱垂方面的有效性，以及对生活质量和性功能的长期影响。
对414例行阴道子宫切除术治疗盆腔器官脱垂（POP）并通过改良麦考尔直肠阴道固定术（A组）或舒尔悬吊术（B组）进行阴道悬吊的患者进行回顾性分析。评估临床特征和同期手术操作。还分析了手术数据以及围手术期和术后并发症。在基线和中位随访时，使用P-QoL、ICIQ-UI-SF、PISQ-12、FSFI、FSDS问卷评估临床特征、泌尿系统症状、POP-Q评分分类、生活质量和性功能。
中位随访时间为8.9年（5.1 - 14.2年）。A组评估了200名女性，B组评估了214名女性。A组和B组各有2例发生阴道穹窿脱垂。两组所有腔室的POP-Q评分均显著降低（p < 0.001），两组之间无显著差异。麦考尔组的总阴道长度（TVL）减少比例更大（p < 0.001）。P-QoL和ICIQ-UI-SF问卷显示两组均有改善（p < 0.001）。两组中定期进行性活动的患者数量均增加，但B组患者使用PISQ-12和FSFI评估的性生活质量更好。
两种手术技术在预防接受阴道子宫切除术的女性阴道穹窿脱垂方面均显示出有效性和安全性，生活质量和性功能有显著改善。舒尔技术在性功能方面显示出更大的改善。
