Chang Chia-Pei, Hsu Fang-Kuo, Lai Man-Jung, Chang Wen-Hsun, Lee Na-Rong, Lee Hui-Ling, Horng Huann-Cheng, Wang Peng-Hui
Department of Obstetrics and Gynecology.
Institute of Clinical Medicine.
Medicine (Baltimore). 2019 Apr;98(14):e15086. doi: 10.1097/MD.0000000000015086.
This article aims to evaluate the safety and outcome of women with pelvic organ prolapse (POP) treated by a minimally invasive bilateral sacrospinous hysteropexy (UPHOLD LITE Vaginal Support System, Boston Scientific) without concomittent anti-incontinence surgery.This retrospective study was conducted between 2014 and 2016. Evaluated items included surgical parameter and postoperative outcome.Three hundred thirteen women with POP were eligible and 22 were excluded because of history of either or more following situations, such as hysterectomy, mesh augmentation, previous anti-incontinence procedures, and radical pelvic surgery before. With a median follow-up of 26 months, surgery-related morbidity rate was 23.7% (69/291), including 1 with bladder injury (0.3%), 2 with hematoma (0.7%), 8 with urinary tract infection (2.8%), 48 with voiding dysfunction (16.5%) and 10 with mesh problems (3.4%). Among these morbidities, 12 patients (4.1%) needed surgical intervention, including 6 for mesh problems, 1 for bladder injury, 2 for hematoma, and 3 for anti-incontinence surgery. The difference of pelvic organ prolapse quantification (POP-Q) stage before and after surgery showed a statistical significance (anterior portion from 1.36 ± 2.60 to -2.69 ± 0.26, posterior portion from -1.29 ± 2.08 to -2.46 ± 0.62, and cervix portion from 2.03 ± 4.80 to -6.98 ± 2.26, all P < .001). At the end of August 2018, re-intervention rate for POP recurrence was 2.1% (n = 6), including abdominal sacrocolpopexy (n = 1), anterior repair (n = 1), vaginal total hysterectomy and uterine-sacral ligament suspension (n = 1), vaginal total hysterectomy and LeFort (n = 1), LeFort (n = 1), and pessary support (n = 1).Because some women developed postoperative lower urinary tract symptom, preoperative evaluation, including careful and detailed history taking, and urodynamic evaluation is suggested. After adequate counseling, uterine-preserving sacrospinal ligament suspension by UPHOLD LITE Vaginal Support System surgery could be considered in the management of women with POP, because of its high successful rate (97.9%) and low morbidity rate.
本文旨在评估采用微创双侧骶棘韧带子宫固定术（UPHOLD LITE阴道支撑系统，波士顿科学公司）治疗且未同时进行抗尿失禁手术的盆腔器官脱垂（POP）女性的安全性及治疗结果。这项回顾性研究于2014年至2016年期间开展。评估项目包括手术参数及术后结果。313例POP女性符合条件，22例因存在以下一种或多种情况的病史被排除，如子宫切除术、网片增强术、既往抗尿失禁手术以及既往根治性盆腔手术。中位随访时间为26个月，手术相关发病率为23.7%（69/291），包括1例膀胱损伤（0.3%）、2例血肿（0.7%）、8例尿路感染（2.8%）、48例排尿功能障碍（16.5%）以及10例网片相关问题（3.4%）。在这些并发症中，12例患者（4.1%）需要手术干预，包括6例网片相关问题、1例膀胱损伤、2例血肿以及3例抗尿失禁手术。手术前后盆腔器官脱垂定量（POP-Q）分期的差异具有统计学意义（前部从1.36±2.60至 -2.69±0.26，后部从 -1.29±2.08至 -2.46±0.62，宫颈部从2.03±4.80至 -6.98±2.26，均P<0.001）。截至2018年8月底，POP复发的再次干预率为2.1%（n = 6），包括腹侧骶骨阴道固定术（n = 1）、前路修补术（n = 1）、阴道全子宫切除术及子宫骶骨韧带悬吊术（n = 1）、阴道全子宫切除术及LeFort术（n = 1）、LeFort术（n = 1）以及子宫托支撑术（n = 1）。由于部分女性术后出现下尿路症状，建议进行术前评估，包括仔细详细的病史采集及尿动力学评估。在进行充分咨询后，对于POP女性的治疗，可考虑采用UPHOLD LITE阴道支撑系统手术进行保留子宫的骶棘韧带悬吊术，因其成功率高（97.9%）且发病率低。
