Clinical Instructor/Fellow, Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL.
Voluntary Assistant Clinical Professor, Department of Reproductive Medicine, University of California, San Diego, La Jolla; Attending Physician, Division of Female Pelvic Medicine and Reconstructive Surgery Kaiser Permanente, San Diego, San Diego, CA.
Obstet Gynecol Surv. 2019 Jul;74(7):429-435. doi: 10.1097/OGX.0000000000000686.
As surgical techniques evolve in the treatment of pelvic organ prolapse and patient preferences are better understood, more studies are investigating uterine-sparing procedures for efficacy, safety, and potentially improved quality of life. Much of the literature reflects the use of mesh material in uterine-sparing procedures, and there is a paucity of data regarding the safety and efficacy of native tissue uterine-sparing procedures for the treatment of pelvic organ prolapse.
To summarize existing evidence regarding objective and subjective outcomes of uterine-preserving procedures including the Manchester procedure (MP) as well as native tissue uterovaginal hysteropexy with repairs, namely, uterosacral hysteropexy (USH) and sacrospinous hysteropexy (SSH), compared with outcomes of total vaginal hysterectomy (TVH) with repairs for the management of uterovaginal prolapse.
A review of the literature included MEDLINE, Cochrane, and clinicaltrials.gov databases.
Few level 1 data exist comparing outcomes of native tissue hysteropexy to vaginal hysterectomy for management of uterovaginal prolapse. In general, outcomes of the MP for the management of uterovaginal prolapse revealed that compared with TVH it is associated with shorter operative times, lower estimated blood loss and risk of blood transfusion with no difference in hospital stay, and similar quality of life and sexual function outcomes. Retrospective data suggest no difference with respect to recurrent prolapse of any compartment between USH and TVH with repairs. Level 1 data reveal that SSH has been shown to have similar 1-year outcomes and safety compared with TVH with native tissue suspension. Women with stage 4 prolapse who undergo an SSH may be at higher risk of recurrence and may benefit from an alternative method of apical prolapse repair.
More level 1 data are needed in order to robustly understand long-term differences in outcomes between native tissue uterine-conserving versus vaginal hysterectomy surgical approaches in women with uterovaginal prolapse.
随着盆腔器官脱垂治疗中手术技术的发展，以及患者偏好的更好理解，越来越多的研究正在调查保留子宫的手术，以评估其疗效、安全性和潜在的生活质量改善。大部分文献反映了在保留子宫的手术中使用网片材料，但对于治疗盆腔器官脱垂的天然组织保留子宫手术的安全性和有效性的数据却很少。
总结现有的关于保留子宫手术（包括曼彻斯特手术（MP））以及天然组织经阴道子宫固定术（包括经子宫骶骨固定术（USH）和经骶骨棘固定术（SSH））的客观和主观结果的证据，与经阴道子宫切除术（TVH）加修补术治疗阴道前壁脱垂的结果进行比较。
对文献进行了综述，包括 MEDLINE、Cochrane 和 clinicaltrials.gov 数据库。
很少有 1 级数据比较天然组织固定术与阴道子宫切除术治疗阴道前壁脱垂的结果。一般来说，MP 治疗阴道前壁脱垂的结果显示，与 TVH 相比，它与较短的手术时间、较低的估计失血量和输血风险相关，而住院时间没有差异，且生活质量和性功能结果相似。回顾性数据表明，USH 加修补术与 TVH 加修补术相比，任何部位的复发性脱垂无差异。1 级数据显示，SSH 在 1 年的结果和安全性方面与 TVH 加天然组织悬吊术相似。接受 SSH 的 4 期脱垂的女性可能有更高的复发风险，可能需要替代的顶脱垂修复方法。
为了更好地了解治疗阴道前壁脱垂的天然组织保留子宫与阴道子宫切除术手术方法之间的长期结果差异，需要更多的 1 级数据。
