Rajan Deepa, Varghese Patsy, Roy Mariam, Roy Kunjamma, David Alice
1Department of Obstetrics and Gynaecology, Believers Church Medical College Hospital, Kuttapuzha, Thiruvalla, Kerala 689103 India.
2Department of Medical Research (Epidemiology & Biostatistics), Believers Church Medical College Hospital, Kuttapuzha, Thiruvalla, Kerala 689103 India.
J Obstet Gynaecol India. 2020 Feb;70(1):57-63. doi: 10.1007/s13224-019-01265-9. Epub 2019 Sep 11.
Advanced uterovaginal prolapse can significantly affect the quality of life in women and usually requires surgical management. McCall's culdoplasty (M) or sacrospinous fixation (SSF) are done at the time of vaginal hysterectomy with pelvic floor repair (VHPFR) to reduce recurrence, but recurrence rates of 15% and 33% have been reported with these procedures respectively. We hypothesize that combining VH-PFR with both McCall's culdoplasty and sacrospinous fixation (VH-PFR-M-SSF) may decrease recurrence rates compared to VH-PFR-M without significantly affecting other perioperative outcomes.
All patients with advanced uterovaginal prolapse and willing for VH-PFR at our institute from January 2015 to March 2018 were included after informed consent, except for medically unfit women and those preferring alternative management. We conducted a case control study comparing VH-PFR-M and VH-PFR-M-SSF with a follow-up period of 24 months. Qualitative and quantitative data were statistically analysed and Odds ratio and 95% Confidence interval was calculated. Kaplan Meier Curve was drawn and Log Rank test was used to compare recurrence.
Out of 174 patients who underwent surgery in the study period, 131 patients (75.28%) underwent VH-PFR-M and 43 patients (24.71%) underwent VH-PFR-M-SSF. Both groups were comparable for age, body mass index, parity, postmenopausal status, comorbidities and aggravating factors. Patients with higher stage of prolapse were more in group 2 ( < 0.001). There were no intraoperative complications or postoperative surgical interventions in either group. The duration of surgery was not significantly different. Change in haematocrit was more in group 2 but no patient required blood transfusion. There was no statistically significant difference in recurrence rates between the 2 groups.
The procedure (VH PFR M-SSF) is safe and affordable with good results in Stage 3 with advanced bulge and stage 4 prolapse.
重度子宫阴道脱垂会显著影响女性生活质量，通常需要手术治疗。在进行阴道子宫切除术加盆底修复术（VHPFR）时，施行麦考尔直肠子宫陷凹成形术（M）或骶棘韧带固定术（SSF）以降低复发率，但据报道这两种手术的复发率分别为15%和33%。我们推测，与单纯VHPFR-M相比，VHPFR联合麦考尔直肠子宫陷凹成形术和骶棘韧带固定术（VH-PFR-M-SSF）可能会降低复发率，且不会显著影响其他围手术期结局。
2015年1月至2018年3月期间，我院所有患有重度子宫阴道脱垂且愿意接受VHPFR的患者，在签署知情同意书后纳入研究，但医学上不适合的女性以及倾向于其他治疗方式的女性除外。我们进行了一项病例对照研究，比较VHPFR-M和VH-PFR-M-SSF，随访期为24个月。对定性和定量数据进行统计学分析，并计算比值比和95%置信区间。绘制Kaplan Meier曲线，采用对数秩检验比较复发情况。
在研究期间接受手术的174例患者中，131例（75.28%）接受了VHPFR-M，43例（24.71%）接受了VH-PFR-M-SSF。两组在年龄、体重指数、产次、绝经后状态、合并症和加重因素方面具有可比性。脱垂程度较高的患者在第2组中更多（<0.001）。两组均未发生术中并发症或术后手术干预。手术时间无显著差异。第2组的血细胞比容变化更大，但无患者需要输血。两组之间的复发率无统计学显著差异。
该手术（VH PFR M-SSF）安全且经济实惠，对于3期重度膨出和4期脱垂效果良好。
