Ekici Mustafa Ayhan, Cetin Caglar, Kayar Batuhan, Albayrak Omür, Topcuoğlu Mehmet Ata, Ural Ulku Mete
Department of Obstetrics and Gynaecology, University of Abant İzzet Baysal, Bolu, Turkey.
Department of Obstetrics and Gynaecology, İzzet Baysal State Hospital, Bolu, Turkey.
Eur J Obstet Gynecol Reprod Biol. 2020 Sep;252:174-180. doi: 10.1016/j.ejogrb.2020.06.028. Epub 2020 Jun 17.
To interpret the long-term outcomes of transvaginal round-infundibulopelvic ligament colposuspension after vaginal hysterectomy in patients with stage 3-4 uterovaginal prolapse.
This retrospective case-control study from 2007 to 2016 analysed patients' medical records and evaluated gynaecological examinations over 11 years of follow-up. One hundred and forty-three patients who underwent transvaginal round-infundibulopelvic ligament colposuspension after vaginal hysterectomy were evaluated. The prespecified primary outcome evaluated at 11-year follow-up was apical prolapse of stage 2 or higher evaluated by the Pelvic Organ Prolapse Quantification System (POP-Q), in combination with bothersome bulge symptoms or repeat surgery for recurrent apical prolapse. The secondary outcome was overall anatomical failure (recurrent prolapse of stage 2 or higher in apical, anterior or posterior compartment). The rate of recurrence of apical prolapse was compared between groups using the McNemar test.
The mean (± standard deviation) follow-up period was 88.15 ± 2.519 months (95 % confidence interval 83.17-93.13). The pre-operative diagnoses were stage 3 uterovaginal prolapse in 23 (16.08 %) patients, stage 4 uterovaginal prolapse in 120 (83.91 %) patients, rectocele in 119 (83.21 %) patients, cystocele in 138 (96.50 %) patients and stress urinary incontinence in 53 (37.06 %) patients. Ten (8.33 %) patients with stage 4 uterovaginal prolapse developed postoperative apical prolapse, whereas none of the patients with stage 3 uterovaginal prolapse developed postoperative apical prolapse. Postoperatively, the POP-Q stages of apical prolapse were significantly lower compared with pre-operatively (p < 0.001). Postoperatively, the apical prolapse rate was 7.0 %, the recurrent cystocele rate was 2.07 %, the recurrent rectocele rate was 5.5 %, and the recurrent stress urinary incontinence rate was 18.87 %. Overall, postoperative anatomical failure occurred in 21 of 143 (14.68 %) women. One (0.69 %) patient developed perioperative bladder perforation, two (1.39 %) patients experienced voiding difficulty, and eight (5.59 %) patients experienced vaginal spotting.
Transvaginal round-infundibulopelvic ligament colposuspension during vaginal hysterectomy is an effective and useful method that reduces the rate of postoperative apical prolapse in patients with high-grade uterovaginal prolapse.
解读3 - 4期子宫阴道脱垂患者在阴道子宫切除术后经阴道圆韧带悬吊术的长期疗效。
这项回顾性病例对照研究涵盖了2007年至2016年期间的患者病历，并在11年的随访中评估了妇科检查情况。对143例在阴道子宫切除术后接受经阴道圆韧带悬吊术的患者进行了评估。在11年随访时评估的预先设定的主要结局是通过盆腔器官脱垂定量系统（POP-Q）评估为2期或更高分期的顶端脱垂，并伴有令人烦恼的膨出症状或因复发性顶端脱垂而再次手术。次要结局是整体解剖学失败（顶端、前部或后部腔室出现2期或更高分期的复发性脱垂）。使用McNemar检验比较各组顶端脱垂的复发率。
平均（±标准差）随访期为88.15±2.519个月（95%置信区间83.17 - 93.13）。术前诊断为3期子宫阴道脱垂的患者有23例（16.08%），4期子宫阴道脱垂的患者有120例（83.91%），直肠膨出的患者有119例（83.21%），膀胱膨出的患者有138例（96.50%），压力性尿失禁的患者有53例（37.06%）。10例（8.33%）4期子宫阴道脱垂患者术后出现顶端脱垂，而3期子宫阴道脱垂患者术后均未出现顶端脱垂。术后，顶端脱垂的POP-Q分期与术前相比显著降低（p < 0.001）。术后，顶端脱垂率为7.0%，复发性膀胱膨出率为2.07%，复发性直肠膨出率为5.5%，复发性压力性尿失禁率为18.87%。总体而言，143名女性中有21名（14.68%）术后出现解剖学失败。1例（0.69%）患者发生围手术期膀胱穿孔，2例（1.39%）患者出现排尿困难，8例（5.59%）患者出现阴道点滴出血。
阴道子宫切除术中经阴道圆韧带悬吊术是一种有效且有用的方法，可降低高级别子宫阴道脱垂患者术后顶端脱垂的发生率。
