Carlin Greta Lisa, Bodner-Adler Barbara, Husslein Heinrich, Ritter Magdalena, Umek Wolfgang
Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Vienna, Austria.
Karl Landsteiner Institute of Special Gynecology and Obstetrics, Vienna, Austria.
Int Urogynecol J. 2021 Apr;32(4):775-783. doi: 10.1007/s00192-020-04572-2. Epub 2020 Nov 5.
Hysterectomy is one of the most commonly performed gynecological surgical procedures. One of the long-term risks associated with hysterectomy is the occurrence of pelvic organ prolapse (POP). To prevent post-hysterectomy POP, several suspension procedures are routinely performed at the time of hysterectomy. We performed a systematic review of published data in order to define the most effective surgical procedures for the prevention of post-hysterectomy POP.
We performed a systematic review of the literature by searching PubMed, the Cochrane Library, EMBASE, Ovid MEDLINE, and clinicaltrials.gov up to 24 May 2020. The search strategy included the keywords hysterectomy, post-hysterectomy, prolapse, colposuspension, culdoplasty, McCall, and combinations thereof. The inclusion criterion was a surgical procedure at the time of hysterectomy to prevent de novo POP. The outcome was incidence of post-hysterectomy POP.
Six out of 553 retrieved studies met the methodological criteria for complete analysis. In this review, 719 women aged over 18 years were included. Only 2 studies were designed as prospective trials; however, only 1 compared women undergoing a procedure at the time of hysterectomy with controls. The prevalence of post-hysterectomy prolapse varied from 0% to 39%.
A systematic review of published literature suggests that performing variations of McCall culdoplasty at the time of hysterectomy might be the most effective prophylactic surgical procedure for preventing post-hysterectomy pelvic organ prolapse.
子宫切除术是最常见的妇科外科手术之一。与子宫切除术相关的长期风险之一是盆腔器官脱垂（POP）的发生。为预防子宫切除术后的POP，在子宫切除时通常会进行几种悬吊手术。我们对已发表的数据进行了系统评价，以确定预防子宫切除术后POP的最有效手术方法。
我们通过检索截至2020年5月24日的PubMed、Cochrane图书馆、EMBASE、Ovid MEDLINE和clinicaltrials.gov对文献进行了系统评价。检索策略包括关键词子宫切除术、子宫切除术后、脱垂、阴道前壁悬吊术、后穹窿成形术、麦考尔手术及其组合。纳入标准是在子宫切除时进行的预防新发POP的手术。结果是子宫切除术后POP的发生率。
553项检索到的研究中有6项符合完整分析的方法学标准。在本评价中，纳入了719名18岁以上的女性。只有2项研究设计为前瞻性试验；然而，只有1项将子宫切除时接受手术的女性与对照组进行了比较。子宫切除术后脱垂的患病率从0%到39%不等。
对已发表文献的系统评价表明，在子宫切除时进行麦考尔后穹窿成形术的变体可能是预防子宫切除术后盆腔器官脱垂的最有效预防性手术方法。
