Zhang Y H, Lu Y X, Liu X, Liu J X, Shen W J, Zhao Y, Niu K, Wang W Y
Department of Obstetrics and Gynecology, Fourth Medical Center, General Hospital of People's Liberation Army, Beijing 100048, China.
Zhonghua Fu Chan Ke Za Zhi. 2019 Jul 25;54(7):445-451. doi: 10.3760/cma.j.issn.0529-567x.2019.07.003.
To assess the five-year effect of the transvaginal high uterosacral ligament suspension (HUS) with or without additional concomitant native-tissue anterior and (or) posterior repair in women suffering from middle compartment defect. A retrospective review of records identified 79 women who underwent transvaginal HUS with or without additional concomitant native-tissue anterior and (or) posterior repair from January 2007 to January 2018 in Fourth Medical Center, General Hospital of People's Liberation Army. The middle compartment defects were predominant in these patients with point C no less than point Ba or Bp if accompanied with anterior or posterior vaginal wall prolapse. Follow-up visits were performed 2,6 and 12 months after surgery and then annually. Anatomic results of pelvic organ prolapse (POP) was established by pelvic examination using pelvic organ prolapse quantitation system (POP-Q) staging. Funtional results were obtained by patient global impression of improvement (PGI-I) scale in POP, pelvic floor distress inventory-short form 20 (PFDI-20) and pelvic floor impact questionnaire short form (PFIQ-7). Surgical success required the fulfillment of all 3 criteria: (1) anterior or posterior vaginal wall prolapsed leading edge of 0 cm or less and apex of 1/2 total vaginal length or less; (2) the absence of POP symptoms as reported on the PFDI-20 question No.3 ( "Do you usually have a bulge or something falling out that you can see or feel in your vaginal area?" ); and (3) no prolapse reoperations or pessary use during the study period. Of 79 women, 51(65%, 51/79) women completed the five-year follow-up during the study period. The median follow-up time was 5.2 years (2.8-8.3 years). The overall surgery success rate was 86% (44/51) according to above all 3 criteria. Prolapse recurrence rates were isolated anterior 8% (4/51), isolated apical 0, isolated posterior 2% (1/51) and multiple compartments 4% (2/51). Seven women (14%,7/51) developed anterior or posterior prolapse beyond the hymen with the leading edge≤1 cm. No apical prolapsed occurred. None of recurrent women underwent retreatment,including either surgery or pessary usage at last follow-up. The subjective satisfaction rate was 90% (46/51). There was a 1% (1/79) rate of intraoperative ureteral kinking and 3% (2/79) rate of postoperative morbidity. The transvaginal HUS for middle compartment defect offers good long-term anatomical results with excellent vault suspension. With additional concomitant native-tissue anterior and (or) posterior repair, it will be a reconstructive surgery for the majority of moderate-to-severe POP. It is minimal traumatic and worthy of being popularized for clinical application.
评估经阴道高位骶子宫韧带悬吊术（HUS）联合或不联合额外的阴道前后壁自体组织修复术对中盆腔缺陷女性的五年疗效。回顾性分析解放军总医院第四医学中心2007年1月至2018年1月期间79例行经阴道HUS联合或不联合额外阴道前后壁自体组织修复术的患者病历。这些患者中盆腔缺陷为主，若伴有阴道前壁或后壁脱垂，则C点不低于Ba点或Bp点。术后2、6和12个月进行随访，之后每年随访一次。采用盆腔器官脱垂定量系统（POP-Q）分期通过盆腔检查确定盆腔器官脱垂（POP）的解剖学结果。通过患者对POP改善的总体印象（PGI-I）量表、盆底功能障碍问卷简表20（PFDI-20）和盆底影响问卷简表（PFIQ-7）获得功能结果。手术成功需要满足所有3项标准：（1）阴道前壁或后壁脱垂前缘≤0 cm，顶端≤阴道总长度的1/2；（2）PFDI-20第3题（“您在阴道区域是否经常看到或感觉到有肿物或东西掉出来？”）报告无POP症状；（3）研究期间无脱垂再次手术或使用子宫托。79例患者中，51例（65%，51/79）在研究期间完成了五年随访。中位随访时间为5.2年（2.88.3年）。根据上述所有3项标准，总体手术成功率为86%（44/51）。脱垂复发率分别为孤立性前壁8%（4/51）、孤立性顶端0、孤立性后壁2%（1/51）和多部位4%（2/51）。7例（14%，7/51）患者出现阴道前壁或后壁脱垂超过处女膜缘，前缘≤1 cm。未发生顶端脱垂。复发患者在最后一次随访时均未接受再次治疗，包括手术或使用子宫托。主观满意率为90%（46/51）。术中输尿管扭结发生率为1%（1/79），术后发病率为3%（2/79）。经阴道HUS治疗中盆腔缺陷可提供良好的长期解剖学结果和出色的穹隆悬吊效果。联合额外的阴道前后壁自体组织修复术，对于大多数中重度POP来说是一种重建手术。它创伤极小，值得临床推广应用。
