San Paolo University Hospital, Milan, Italy.
EOC-Beata Vergine Hospital, Mendrisio, Switzerland.
Int Urogynecol J. 2020 Nov;31(11):2225-2231. doi: 10.1007/s00192-020-04474-3. Epub 2020 Aug 18.
Uterine-sparing prolapse surgery has been gaining back popularity with clinicians and patients. Although both prosthetic and native-tissue surgery procedures are described, the latter is progressively regaining a central role in pelvic reconstructive surgery, owing to a lack of mesh-related complications. Available native-tissue procedures have different advantages and pitfalls, as well as different evidence profiles. Most of them offer anatomical and subjective outcomes comparable with those of hysterectomy-based procedures. Moreover, native-tissue procedures in young women desiring childbearing allow to avoid synthetic material implantation, which may lead to potentially serious complications during pregnancy. As a consequence, we do think that offering a reconstructive native-tissue procedure for uterine preservation (with the exception of the Manchester procedure) is the safest option in women wishing for pregnancy. Sacrospinous ligament hysteropexy and high uterosacral ligament hysteropexy may be considered first-line options in consideration of the higher level of evidence and lack of adverse obstetrical outcomes.
保留子宫的脱垂手术在临床医生和患者中重新受到欢迎。虽然有假体和自体组织手术程序的描述，但由于缺乏与网片相关的并发症，后者在盆底重建手术中逐渐重新占据中心地位。现有的自体组织手术具有不同的优点和缺陷，以及不同的证据水平。它们中的大多数提供与基于子宫切除术的手术相当的解剖学和主观结果。此外，对于希望生育的年轻女性，自体组织手术可以避免植入合成材料，这可能会在怀孕期间导致潜在的严重并发症。因此，我们认为对于希望怀孕的女性，提供一种保留子宫的重建自体组织手术（除了曼彻斯特手术）是最安全的选择。骶骨固定悬吊带和高子宫骶骨固定悬吊带可以被认为是一线选择，因为它们具有更高的证据水平和缺乏不良产科结局。
