继续前行：有多少女性在脱垂使用子宫托后选择手术？

Moving On: How Many Women Opt for Surgery After Pessary Use for Prolapse?

机构信息

From the Division of Urogynecology and Reconstructive Pelvic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC.

出版信息

Female Pelvic Med Reconstr Surg. 2020 Jun;26(6):387-390. doi: 10.1097/SPV.0000000000000731.

DOI:10.1097/SPV.0000000000000731

PMID:31335479

Abstract

OBJECTIVE

Our primary objective was to evaluate the proportion of women who underwent surgery after successful pessary fitting for pelvic organ prolapse (POP). Our secondary objectives were to assess when surgery occurs and to evaluate factors associated with choosing surgery as compared to continuing with a pessary.

METHODS

Our study population included women successfully fitted with a pessary for POP 1/1/12 and 12/31/16. We excluded non-English-speaking women and those who used pessary only as a bridge until surgery. We evaluated events occurring after a successful fitting, including whether women (1) continued pessary use, (2) underwent surgery, or (3) discontinued pessary without surgery. Our primary outcome was the proportion of women who opted for surgery after a successful pessary fitting for POP. We also assessed the median time to surgery and compared women who underwent surgery with those who continued with a pessary to assess variables associated with surgery.

RESULTS

Of the 444 women with POP who were successfully fitted with a pessary and met inclusion criteria, 137 (31%) ultimately underwent surgery. The median time to surgery was 10 months (interquartile range, 4-18), with 59% having surgery within 1 year, and 89% within 2 years. In a logistic regression analysis controlling for age in decades, advanced POP stage, and Charlson Comorbidity Index, younger age remained significantly associated with surgery (odds ratio, 0.77, 95% confidence interval, 0.62-0.95; P = 0.02).

CONCLUSIONS

Among women successfully fitted with a pessary for POP, one third ultimately underwent surgery, with approximately 60% of these women undergoing surgery within the first year and 90% within 2 years.

摘要

目的

我们的主要目的是评估成功使用子宫托治疗盆腔器官脱垂（POP）后接受手术的女性比例。我们的次要目的是评估手术发生的时间，并评估与选择手术相比继续使用子宫托的相关因素。

方法

我们的研究人群包括 2012 年 1 月 1 日至 2016 年 12 月 31 日成功使用子宫托治疗 POP 的女性。我们排除了不会讲英语的女性以及仅将子宫托用作手术桥梁的女性。我们评估了成功佩戴子宫托后的事件发生情况，包括女性（1）是否继续使用子宫托，（2）是否接受手术，或（3）是否未进行手术而停止使用子宫托。我们的主要结局是成功使用子宫托治疗 POP 后选择手术的女性比例。我们还评估了手术的中位时间，并比较了接受手术的女性与继续使用子宫托的女性，以评估与手术相关的变量。

结果

在 444 名患有 POP 并成功佩戴子宫托且符合纳入标准的女性中，有 137 名（31%）最终接受了手术。手术的中位时间为 10 个月（四分位距，4-18），其中 59%在 1 年内进行手术，89%在 2 年内进行手术。在控制年龄十年、POP 晚期和 Charlson 合并症指数的 logistic 回归分析中，年龄较小与手术显著相关（比值比，0.77，95%置信区间，0.62-0.95；P = 0.02）。