Thomas Tonya N, Davidson Emily R W, Lampert Erika J, Paraiso Marie F R, Ferrando Cecile A
Center for Urogynecology & Pelvic Reconstructive Surgery, Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, 9500 Euclid Avenue A81, Cleveland, OH, 44195, USA.
Int Urogynecol J. 2020 Sep;31(9):1763-1770. doi: 10.1007/s00192-020-04291-8. Epub 2020 Apr 6.
Large, long-term studies are needed to compare pelvic organ prolapse (POP) recurrence and mesh exposure following all modes of sacrocolpopexy (open, robotic, and laparoscopic). We hypothesized that the prevalence of recurrent POP and mesh exposure does not differ between modes of sacrocolpopexy.
This is a retrospective cohort study with a cross-sectional, prospective survey. Participants were surveyed regarding complications, retreatments, and symptoms following sacrocolpopexy. Baseline characteristics, POP recurrence, mesh exposure, and survey responses were compared.
A total of 709 participants met the criteria. Median time from sacrocolpopexy to last follow-up for all participants was 0.5 years (2 days to 13.4 years). 15.0% experienced recurrent stage 2 or greater POP or underwent retreatment (open 11.7% [95% CI 7.8-17.2%]; robotic 21.1% [95% CI 15.6-27.9%]; laparoscopic 13.8% [95% CI 10.6-17.9%]; p = 0.03). After adjusting for baseline differences there was no significant difference among groups (p = 0.30). 5.3% experienced mesh and/or suture exposure (mesh n = 19, suture n = 10, mesh and suture n = 8) with no significant difference among groups (open 7.7% [95% CI 4.6-12.5%]; robotic 3.6% [95% CI 1.7-7.6%]; laparoscopic 4.9% [95% CI 3.1-7.7%]; p = 0.20). Median time from sacrocolpopexy to survey completion was 6.5 (1.6-13.4) years. 9.2% reported evaluation or treatment for recurrent POP (open 6.3% [95% CI 2.1-16.8%]; robotic 12.5% [95% CI 6.9-21.5%]; laparoscopic 8.5% [5.1-13.8%]; p = 0.44). 6.9% reported evaluation or treatment for mesh exposure (open 6.0% [95% CI 2.1-16.2%]; robotic 3.9% [95% CI 1.3-10.7%]; laparoscopic 8.6% [5.2-13.9%]; p = 0.38).
Objective and patient-reported long-term prevalence of POP recurrence and mesh exposure are low following all modes of sacrocolpopexy.
需要开展大规模的长期研究，以比较各种骶骨阴道固定术（开放手术、机器人辅助手术和腹腔镜手术）后盆腔器官脱垂（POP）复发及网片暴露情况。我们假设不同方式的骶骨阴道固定术后POP复发率和网片暴露率无差异。
这是一项回顾性队列研究，并进行了横断面、前瞻性调查。就骶骨阴道固定术后的并发症、再次治疗及症状对参与者进行了调查。比较了基线特征、POP复发、网片暴露及调查结果。
共有709名参与者符合标准。所有参与者从骶骨阴道固定术至最后一次随访的中位时间为0.5年（2天至13.4年）。15.0%的患者经历了2期或更严重的POP复发或接受了再次治疗（开放手术组为11.7%[95%CI 7.8 - 17.2%]；机器人辅助手术组为21.1%[95%CI 15.6 - 27.9%]；腹腔镜手术组为13.8%[95%CI 10.6 - 17.9%]；p = 0.03）。在对基线差异进行校正后，各组之间无显著差异（p = 0.30）。5.3%的患者出现了网片和/或缝线暴露（网片暴露19例，缝线暴露10例，网片和缝线均暴露8例），各组之间无显著差异（开放手术组为7.7%[95%CI 4.6 - 12.5%]；机器人辅助手术组为3.6%[95%CI 1.7 - 7.6%]；腹腔镜手术组为4.9%[95%CI 3.1 - 7.7%]；p = 0.20）。从骶骨阴道固定术至调查完成的中位时间为6.5（1.6 - 13.4）年。9.2%的患者报告因POP复发接受了评估或治疗（开放手术组为6.3%[95%CI 2.1 - 16.8%]；机器人辅助手术组为12.5%[95%CI 6.9 - 21.5%]；腹腔镜手术组为8.5%[5.1 - 13.8%]；p = 0.44）。6.9%的患者报告因网片暴露接受了评估或治疗（开放手术组为6.0%[95%CI 2.1 - 16.2%]；机器人辅助手术组为3.9%[95%CI 1.3 - 10.7%]；腹腔镜手术组为8.6%[5.2 - 13.9%]；p = 0.38）。
各种方式的骶骨阴道固定术后，客观及患者报告的POP复发和网片暴露的长期发生率均较低。
