Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, Beijing, China.
Menopause. 2020 Oct;27(10):1148-1154. doi: 10.1097/GME.0000000000001633.
To evaluate the success rate of pessary fitting and continuation rate for symptomatic pelvic organ prolapse (POP) patients with a hysterectomy and to explore potential predictors.
In this prospective observational study, 119 symptomatic POP patients with a prior hysterectomy received pessary treatment between April 2015 and February 2019. A successful pessary fitting was defined as a patient who was fitted with a pessary and continued to use it 2 weeks later. Patients with successful pessary fitting were followed until February 2020. Data analysis was performed with t tests, nonparametric tests, chi-square tests, and logistic regression.
The success rate of pessary fitting was 63.2%. A history of POP reconstructive surgery (OR = 2.6, 95% CI 1.0-6.7, P = 0.043) and a short total vaginal length <7.3 cm, (OR = 0.5, 95% CI 0.3-0.9, P = 0.014) were potential risk factors for unsuccessful pessary fitting. A total of 78.1% of the patients continued pessary use for a median duration of 26 months. Among patients who discontinued, 75% ceased within 1 year. Older age (OR = 1.1, 95% CI 1.0-1.2, P = 0.038) and prolapse score improvement at 3 months less than 50% (OR = 2.8, 95% CI 1.1-7.2, P = 0.035) were potential risk factors for discontinuation.
Pessaries remain a useful approach to treat prolapse in women who had a hysterectomy. Patients with POP reconstructive surgery and total vaginal length<7.3 cm should be informed that they might have lower success rate of pessary fitting. Age and prolapse score improvement at 3 months were potential predictors for continuation.
评估子宫切除术后患有症状性盆腔器官脱垂（POP）的患者使用子宫托的成功率和持续性，并探讨潜在的预测因素。
在这项前瞻性观察研究中，2015 年 4 月至 2019 年 2 月期间，119 例患有症状性 POP 的子宫切除术后患者接受了子宫托治疗。子宫托适配成功的定义为患者适配了子宫托并在 2 周后继续使用。对适配成功的患者进行随访，直至 2020 年 2 月。采用 t 检验、非参数检验、卡方检验和逻辑回归进行数据分析。
子宫托适配成功率为 63.2%。POP 重建手术史（OR=2.6，95%CI 1.0-6.7，P=0.043）和总阴道长度<7.3cm（OR=0.5，95%CI 0.3-0.9，P=0.014）是子宫托适配失败的潜在危险因素。共有 78.1%的患者继续使用子宫托，中位使用时间为 26 个月。在停用子宫托的患者中，75%在 1 年内停止使用。年龄较大（OR=1.1，95%CI 1.0-1.2，P=0.038）和 3 个月时脱垂评分改善<50%（OR=2.8，95%CI 1.1-7.2，P=0.035）是停用的潜在危险因素。
子宫托仍然是治疗子宫切除术后患有脱垂的女性的一种有效方法。POP 重建手术和总阴道长度<7.3cm的患者应被告知，他们可能适配子宫托的成功率较低。年龄和 3 个月时脱垂评分的改善是持续使用的潜在预测因素。
