Husby Karen Ruben, Larsen Michael Due, Lose Gunnar, Klarskov Niels
Department of Obstetrics and Gynecology, Herlev and Gentofte University Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark.
University of Copenhagen, Copenhagen, Denmark.
Int Urogynecol J. 2019 Nov;30(11):1887-1893. doi: 10.1007/s00192-019-03950-9. Epub 2019 May 3.
Uterine prolapse is a common diagnosis. Today no consensus exists on which operation technique is ideal to treat apical prolapse. Vaginal hysterectomy (VH) with suspension of the vaginal cuff is the most frequently used. The popularity of uterus-preserving techniques is increasing. The aim of this study was to compare the efficiency of vaginal native tissue operations to treat primary apical prolapse, evaluated on risk of relapse surgery.
Data were obtained from the Danish National Patient Registry (NPR), which contains all operations performed in Denmark. Patients operated on for primary apical prolapse in Denmark 2010-2016 were included and followed until 2017. Clinical data were obtained from the Danish Urogynecological Database. Patients who were previously hysterectomized or operated on for prolapse in the apical compartment were excluded. Data were analyzed using Cox proportional hazard regression analysis and adjusted for age, BMI, smoking, preoperative prolapse stage and previous POP operations.
In total, 7247 operations were included. The hazard ratio (HR) for relapse operation in the apical compartment was significantly higher after sacrospinous hysteropexy (SH) compared with the Manchester-Fothergill procedure (MP) [40.2 confidence interval (CI) 21.6-74.7] and VH (8.5 CI: 6.0-12.1). Likewise, the HR was higher in the anterior compartment after SH compared with MP (4.3 CI: 2.9-6.4) and VH (2.8 CI: 2.0-4.0). No convincing difference was found in the posterior compartment. The 5-year reoperation rates were 30%, 7% and 11% after SH, MP, and VH, respectively.
Sacrospinous hysteropexy has exceedingly high numbers of reoperations due to prolapse recurrence.
子宫脱垂是一种常见诊断。目前对于治疗顶端脱垂的理想手术技术尚无共识。阴道子宫切除术（VH）加阴道断端悬吊术是最常用的方法。保留子宫技术的应用正在增加。本研究的目的是比较阴道自体组织手术治疗原发性顶端脱垂的效果，并根据复发手术风险进行评估。
数据来自丹麦国家患者登记处（NPR），其中包含在丹麦进行的所有手术。纳入2010年至2016年在丹麦接受原发性顶端脱垂手术的患者，并随访至2017年。临床数据来自丹麦泌尿妇科数据库。排除既往接受过子宫切除术或顶端区域脱垂手术的患者。使用Cox比例风险回归分析对数据进行分析，并对年龄、体重指数、吸烟情况、术前脱垂分期和既往盆底器官脱垂手术进行校正。
共纳入7247例手术。与曼彻斯特 - 福瑟吉尔手术（MP）[40.2，置信区间（CI）21.6 - 74.7]和VH（8.5，CI：6.0 - 12.1）相比，骶棘韧带子宫固定术（SH）后顶端区域复发手术的风险比（HR）显著更高。同样，与MP（4.3，CI：2.9 - 6.4）和VH（2.8，CI：2.0 - 4.0）相比，SH后前区域的HR也更高。后区域未发现有说服力的差异。SH、MP和VH后的5年再次手术率分别为30%、7%和11%。
由于脱垂复发，骶棘韧带子宫固定术的再次手术数量极高。
