Department of Gynecology, Gynecologic Oncology, and Gynecologic Endocrinology, Medical University of Gdańsk, Poland.
Neurourol Urodyn. 2019 Nov;38(8):2031-2050. doi: 10.1002/nau.24115. Epub 2019 Aug 26.
Apical defect is a pelvic organ prolapse disorder, with 5%-15% prevalence. The aim of the study was to investigate methods of laparoscopic repair of apical defect and compare them with other techniques (open, vaginal, and robotic).
A systematic search of the literature was conducted in MEDLINE/PubMed and ClinicalTrials.gov databases using the following key words: apical prolapse and treatment procedures. The search was limited by using the humans filters. Only articles published in English between 2010 and 2018 were considered. Two independent authors reviewed the publications for inclusion on the basis of the following criteria: (a) use of laparoscopic techniques, and (b) apical support loss as indication for surgery.
A total of 1002 papers were initially identified; 24 studies fulfilled the inclusion criteria. Four main laparoscopic procedures were found. The reported anatomical success rate (POP-Q < II stage) was 77%-100%, with patient satisfaction for pectopexy, laparoscopic sacropexy (LS), lateral ligament suspension and laparoscopic uterosacral ligament suspension (LUSLS) of 96.4%-97.6%, 71.0%-100%, 66.7%-87.8%, and 95%-95.5%, respectively. Major complications included hemorrhage, bladder, ureter, and/or bowel injuries were rare. Prolapse recurrences after LUSLS and LS were reported in 13.2% and 10.4% of patients, respectively; with reoperation rate for LS 2.2%-12.8%.
Most studies reported anatomical and subjective outcomes, with follow-up ranging from 1 month to >7 years. Success rates for laparoscopic and abdominal corrections of apical defect were similar; laparoscopy was superior in terms of perioperative blood loss, length of hospital stay, and recovery.
顶脱垂是一种盆腔器官脱垂疾病，其发病率为 5%-15%。本研究旨在探讨腹腔镜修复顶脱垂的方法，并与其他方法（开腹、阴道和机器人）进行比较。
在 MEDLINE/PubMed 和 ClinicalTrials.gov 数据库中进行系统文献检索，使用以下关键词：顶脱垂和治疗程序。搜索仅限于人类过滤器。仅考虑 2010 年至 2018 年期间以英文发表的文章。两名独立作者根据以下标准审查出版物是否纳入：（a）使用腹腔镜技术，以及（b）顶脱垂支持物丧失作为手术指征。
最初确定了 1002 篇论文；24 项研究符合纳入标准。发现了 4 种主要的腹腔镜手术。报告的解剖成功率（POP-Q<Ⅱ期）为 77%-100%，对于后盆腔固定术、腹腔镜骶骨固定术（LS）、侧韧带悬吊术和腹腔镜子宫骶骨韧带悬吊术（LUSLS），患者满意度为 96.4%-97.6%、71.0%-100%、66.7%-87.8%和 95%-95.5%。主要并发症包括出血、膀胱、输尿管和/或肠损伤罕见。LUSLS 和 LS 后脱垂复发率分别为 13.2%和 10.4%，LS 再次手术率为 2.2%-12.8%。
大多数研究报告了解剖学和主观结果，随访时间从 1 个月到>7 年不等。腹腔镜和腹部纠正顶脱垂的成功率相似；腹腔镜在围手术期出血量、住院时间和恢复方面具有优势。
