Bataller Eduardo, Ros Cristina, Anglès Sonia, Gallego Miriam, Espuña-Pons Montserrat, Carmona Francisco
Institut Clínic de Ginecologia, Obstetrícia i Neonatologia (ICGON), Hospital Clínic i Provincial de Barcelona, Universitat de Barcelona, Barcelona, Spain.
Institut Clínic de Ginecologia, Obstetrícia i Neonatologia (ICGON), ICGON, Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
Int Urogynecol J. 2019 Apr;30(4):545-555. doi: 10.1007/s00192-018-3702-7. Epub 2018 Jul 9.
Few studies have compared the different approaches of mesh surgery in patients with severe pelvic organ prolapse (POP). In addition to laparoscopic sacrocolpopexy/cervicopexy (LSC-Cx), anterior vaginal mesh (AVM) may be an effective approach for correcting anterior vaginal wall associated with apical POP in women with advanced POP.
A randomised controlled trial (RCT; January 2011 to March 2016) including 120 patients (60/group) with advanced symptomatic POP, with a predominant anterior vaginal wall descent stage III or greater in combination with a stage II or III apical defect (uterus or vaginal vault). Patients underwent four visits: baseline, 3, 6 and12 months after surgery. The main outcome was anatomical success defined as anterior and posterior vaginal wall not descending beyond the hymen and vaginal apex descent no more than one third into the vagina. Secondary variables: PFDI, ICIQ-UI-SF, intraoperative variables, postoperative morbidity and complications.
Anatomical success was achieved with LSC-Cx in 79% and with AVM in 76% (NS). No statistically significant differences were found among POP-Q anterior vaginal wall points between groups, whereas better results were obtained with LSC-Cx in posterior vaginal wall points and total vaginal length. Intraoperative outcomes were similar in the two groups, except for operating time (78.05 min LSC-Cx vs 44.28 min AVM). There were no statistically significant differences related to de novo stress urinary incontinence and dyspareunia. Worse results were found in the CRADI-8 in the LSC-Cx group, owing to constipation. Late postoperative complications and reinterventions were similar in the two groups.
No differences were found in the anatomical correction of anterior and apical POP. The LSC-Cx group presented better correction of posterior vaginal wall defects and a longer total vaginal length.
很少有研究比较严重盆腔器官脱垂（POP）患者行网状手术的不同方法。除了腹腔镜骶骨阴道固定术/宫颈固定术（LSC-Cx）外，前阴道网片（AVM）可能是一种有效方法，用于纠正晚期POP女性患者中与顶端POP相关的阴道前壁脱垂。
一项随机对照试验（RCT；2011年1月至2016年3月），纳入120例有症状的晚期POP患者（每组60例），主要为阴道前壁重度脱垂III期或更严重，合并II期或III期顶端缺陷（子宫或阴道穹窿）。患者接受4次随访：基线、术后3个月、6个月和12个月。主要结局为解剖学成功，定义为阴道前壁和后壁不降至处女膜以下，阴道顶端脱垂不超过阴道内三分之一。次要变量：盆腔功能障碍指数（PFDI）、国际尿失禁咨询委员会尿失禁问卷简表（ICIQ-UI-SF）、术中变量、术后发病率和并发症。
LSC-Cx组解剖学成功率为79%，AVM组为76%（无统计学差异）。两组间POP-Q阴道前壁各点无统计学显著差异，而LSC-Cx组在阴道后壁各点和阴道总长度方面效果更好。两组术中结果相似，但手术时间不同（LSC-Cx组78.05分钟，AVM组44.28分钟）。新发压力性尿失禁和性交困难无统计学显著差异。LSC-Cx组因便秘在CRADI-8评分中结果较差。两组术后晚期并发症和再次干预情况相似。
在阴道前壁和顶端POP的解剖学矫正方面未发现差异。LSC-Cx组在阴道后壁缺陷矫正和阴道总长度方面表现更好。
