Villot Anne, Pizzoferrato Anne-Cécile, Longie Annie, Paniel Bernard-Jean, Fauconnier Arnaud
Department of Gynaecology and Obstetrics, University Hospital of Caen, Caen, France; Caen Normandie University, Caen, France.
Department of Gynaecology and Obstetrics, University Hospital of Caen, Caen, France; Research Unit EA7285, Risk and Safety in Clinical Medicine for Women and Perinatal Health, Versailles St-Quentin University, Montigny-le-Bretonneux, France.
Eur J Obstet Gynecol Reprod Biol. 2020 Apr;247:73-79. doi: 10.1016/j.ejogrb.2020.02.001. Epub 2020 Feb 5.
At the time of controversies on surgical treatment of pelvic organ prolapse, our aim was to describe an effective technique of hysterocolpectomy with colpocleisis for elderly patients not wishing to maintain vaginal sexual activity and present mid-term results including pelvic floor symptoms and quality of life, patient satisfaction and surgical complications using validated scores.
We conducted a retrospective study of all patients having undergone this surgery between June 2006 and June 2016. Women were examined using POP-Q classification and completed validated questionnaires concerning symptoms and quality of life before and after the surgery. Patient satisfaction was assessed using the PGI-I. Complications were described according to the Clavien-Dindo classification.
During the 10-year period, 37 women underwent the surgery with a mean age at surgery of 81.2 years (range: 61-93 years). One per-operative complication occurred (a rectal wound that was sutured) and five Clavien-Dindo grade 3b postoperative complications. Three repeat operations were necessary within 15 days; one suburethral sling had to be lowered because of urinary retention; one tension-free vaginal tape had to be unilaterally sectioned for acute urinary retention; and one woman presented a pararectal abscess requiring surgical drainage. The mean duration of hospitalization was 5.5 (+/-4.2) days. The mean follow-up time was 44.1 (±30.1) months. All symptoms and quality of life scores decreased significantly after the surgery and patient satisfaction was good (PGI-I score = 1.55 +/-0.8).
Hysterocolpectomy with colpocleisis appears to be an effective treatment with a high level of patient satisfaction among the elderly.
在盆腔器官脱垂手术治疗存在争议之时，我们的目的是描述一种针对不希望维持阴道性活动的老年患者的子宫结肠切除术联合阴道封闭术的有效技术，并使用经过验证的评分呈现中期结果，包括盆底症状和生活质量、患者满意度及手术并发症。
我们对2006年6月至2016年6月期间接受该手术的所有患者进行了一项回顾性研究。使用盆腔器官脱垂定量分期（POP-Q）分类法对女性进行检查，并让她们在手术前后完成有关症状和生活质量的经过验证的问卷。使用患者总体印象改善量表（PGI-I）评估患者满意度。根据Clavien-Dindo分类法描述并发症。
在这10年期间，37名女性接受了手术，手术时的平均年龄为81.2岁（范围：61 - 93岁）。发生了1例术中并发症（直肠伤口缝合）和5例Clavien-Dindo 3b级术后并发症。15天内需要进行3次再次手术；1例因尿潴留不得不降低尿道下吊带；1例因急性尿潴留不得不单侧切断无张力阴道吊带；1名女性出现直肠旁脓肿需要手术引流。平均住院时间为5.5（±4.2）天。平均随访时间为44.1（±30.1）个月。手术后所有症状和生活质量评分均显著下降，患者满意度良好（PGI-I评分为1.55±0.8）。
子宫结肠切除术联合阴道封闭术似乎是一种有效的治疗方法，在老年患者中患者满意度较高。
