Department of Obstetrics and Gynecology, Herlev and Gentofte University Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.
University of Copenhagen, Copenhagen, Denmark.
Int Urogynecol J. 2021 Jun;32(6):1441-1449. doi: 10.1007/s00192-020-04515-x. Epub 2020 Sep 8.
Hysterectomy is frequently performed and associated with increased risk of subsequent genital prolapse including vaginal vault prolapse. Ipsilateral uterosacral ligament suspension (IUSLS) and sacrospinous ligament fixation (SSLF) are two commonly performed surgical techniques to treat vaginal vault prolapse. There is no consensus on the ideal operation technique. The aim of this study was to compare IUSLS and SSLF to treat vaginal vault prolapse based on the number of repeat surgeries.
Previously hysterectomized patients operated on with IUSLS or SSLF in Denmark in 2010-2016 were included in this nationwide register-based cohort study and followed until June 2017. Data were obtained from Danish National Databases, to which reporting is mandatory by law, entailing high validity and completeness of data. Data were analyzed using Cox proportional hazard regression analysis adjusted for age, preoperative prolapse stage, smoking, BMI, and previous prolapse surgery.
In total, 744 patients were included; 384 underwent IUSLS while 360 underwent SSLF. After 5 years, 6.5% of patients operated on with IUSLS and 21.8% operated on with SSLF had a repeat surgery in the apical compartment and 12.4% and 30.6% in any compartment, respectively. The risk of repeat surgery was 4.8 times higher after SSLF compared to IUSLS [confidence interval (CI): 2.7-8.4] in the apical compartment and 2.4 times higher (CI: 1.2-5.1) in the anterior compartment. No difference was seen in the posterior compartment.
This study finds significantly higher numbers of repeat surgeries after SSLF compared to after IUSLS in a Danish nationwide cohort.
子宫切除术经常进行，并且与随后的生殖器脱垂（包括阴道穹窿脱垂）的风险增加相关。同侧子宫骶骨韧带悬吊术（IUSLS）和骶棘韧带固定术（SSLF）是两种常用于治疗阴道穹窿脱垂的手术技术。目前对于理想的手术技术尚未达成共识。本研究的目的是比较 IUSLS 和 SSLF 治疗阴道穹窿脱垂的效果，主要依据是再次手术的数量。
本研究是一项基于丹麦全国性注册的队列研究，纳入了 2010 年至 2016 年期间在丹麦接受 IUSLS 或 SSLF 手术的、此前曾接受过子宫切除术的患者，并随访至 2017 年 6 月。数据来自丹麦国家数据库，法律要求这些数据库必须报告，这保证了数据的高度有效性和完整性。使用 Cox 比例风险回归分析对年龄、术前脱垂阶段、吸烟、BMI 和既往脱垂手术等因素进行调整。
共纳入 744 例患者，其中 384 例行 IUSLS，360 例行 SSLF。5 年后，IUSLS 组中有 6.5%的患者在前哨间隙再次手术，而 SSLF 组中有 21.8%的患者再次手术；IUSLS 组中有 12.4%的患者在任何间隙再次手术，而 SSLF 组中有 30.6%的患者再次手术。SSL 组在前哨间隙的再次手术风险是 IUSLS 组的 4.8 倍（95%CI：2.7-8.4），在前部间隙的再次手术风险是 IUSLS 组的 2.4 倍（95%CI：1.2-5.1），而后部间隙未见差异。
本研究在丹麦全国性队列中发现，与 IUSLS 相比，SSL 术后再次手术的数量明显更高。
