Cedars-Sinai Medical Center, Division of Urology, Los Angeles, California.
Stanford University School of Medicine, Department of Obstetrics and Gynecology, Stanford, California.
J Urol. 2021 Jan;205(1):191-198. doi: 10.1097/JU.0000000000001239. Epub 2020 Jul 10.
Colpocleisis is an obliterative surgical option for women with pelvic organ prolapse that is often performed in a frail population. However, because outcomes remain largely unknown we aimed to assess the durability and perioperative safety of colpocleisis in a large population based cohort.
All women undergoing colpocleisis and other pelvic organ prolapse repairs in California (2005-2011) were identified using the Office of Statewide Health Planning and Development data sets. Durability was defined as the absence of future pelvic organ prolapse repair after index repair for the duration of the data sets. Thirty-day morbidity was assessed by identifying readmissions, repeat surgeries and complications. A metric to assess frailty in large administrative databases was applied to assess the impact of frailty on outcomes. Colpocleisis outcomes were compared to other types of pelvic organ prolapse repairs by developing propensity score matched groups.
Among the 2,707 women undergoing colpocleisis, reoperation for prolapse occurred in 47 (1.8%). At least 1 complication occurred in 11.1% of the cohort, with serious complications occurring in 2%. Frail patients were more likely to experience any complication (23.3% vs 10.3%, p <0.01) and a serious complication (5.0% vs 1.8%, p=0.02) and was the best predictor of morbidity. Colpocleisis was associated with a more durable repair (overall failure 1.8% vs 3.5%, p <0.01) with no difference in complication rates as compared to the matched cohort.
Colpocleisis provides a more durable outcome than reconstructive pelvic organ prolapse repairs without increased perioperative morbidity. Frailty is a better predictor than age for perioperative complications after colpocleisis.
阴道封闭术是一种针对盆腔器官脱垂的闭塞性手术选择，通常在体弱人群中进行。然而，由于结果仍知之甚少，我们旨在评估在一个大型人群队列中阴道封闭术的耐久性和围手术期安全性。
使用加利福尼亚州的州卫生计划和发展办公室数据集，确定所有接受阴道封闭术和其他盆腔器官脱垂修复手术的女性（2005-2011 年）。耐久性定义为在数据集的持续时间内，索引修复后未来盆腔器官脱垂修复的缺失。通过确定再入院、重复手术和并发症来评估 30 天发病率。应用一种评估大型行政数据库中虚弱的指标来评估虚弱对结果的影响。通过开发倾向评分匹配组，将阴道封闭术的结果与其他类型的盆腔器官脱垂修复进行比较。
在 2707 名接受阴道封闭术的女性中，有 47 名（1.8%）因脱垂而再次手术。该队列中有 11.1%的患者至少发生 1 种并发症，严重并发症发生率为 2%。虚弱患者更有可能发生任何并发症（23.3%比 10.3%，p<0.01）和严重并发症（5.0%比 1.8%，p=0.02），是发病率的最佳预测指标。阴道封闭术与更持久的修复相关（总体失败率 1.8%比 3.5%，p<0.01），与匹配队列相比，并发症发生率没有差异。
阴道封闭术与重建性盆腔器官脱垂修复相比，提供了更持久的结果，且围手术期发病率没有增加。与年龄相比，虚弱是阴道封闭术后围手术期并发症的更好预测指标。
