Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Obstetrics and Gynecology, Xiamen Chang Gung Hospital, Xiamen, China.
Low Urin Tract Symptoms. 2021 Apr;13(2):249-256. doi: 10.1111/luts.12361. Epub 2020 Dec 1.
This study investigated the effectiveness of sacrospinous ligament fixation (SSLF) and whether uterine preservation reduces the anatomical recurrence rate.
The medical records of 82 patients who received SSLF in a single medical center were reviewed retrospectively. Anatomical recurrence was defined as Pelvic Organ Prolapse-Quantification stage 2 or higher in any compartment. The primary outcome was intergroup analysis for uterine preservation and concomitant hysterectomy patients. The secondary outcomes were anatomical recurrence risk factors and the incidence of adverse events. Propensity score matching (PSM) was used to adjust for demographic differences between groups.
The anatomical recurrence rate was 19.5%, and the retreatment rate was 11.0% (mean follow-up duration: 22.9 months). Cystocele was the most common recurrent compartment (17.1%). The uterine preservation group (n = 66) was younger, had lower parity, and had fewer stage 3 to 4 cystoceles and uterine prolapses than the concomitant hysterectomy group (n = 16). Shorter operation times (99.4 minutes vs 153.7 minutes, P = .002) and lower anatomical recurrence rates (11.5% vs 45.5%, P = .039) were found in the uterine preservation group before and after PSM. Previous pelvic organ prolapse surgery (hazard ratio 3.14) and concomitant hysterectomy (hazard ratio 4.08) were identified as risk factors for anatomical recurrence. The most common adverse event was buttock pain (14.6%), which resolved spontaneously within 4 weeks.
SSLF is an effective surgical method using native tissue for pelvic reconstruction. Compared with concomitant hysterectomy, SSLF with uterine preservation reduces the anatomical recurrence rate.
本研究旨在探讨骶骨固定术（SSLF）的有效性，以及保留子宫是否能降低解剖复发率。
回顾性分析了在一家医疗中心接受 SSLF 的 82 例患者的病历。解剖学复发定义为任何部位的盆腔器官脱垂定量（POP-Q）分期 2 级或更高级别。主要结局是保留子宫和同时行子宫切除术患者的组间分析。次要结局是解剖复发的危险因素和不良事件的发生率。采用倾向评分匹配（PSM）调整组间的人口统计学差异。
解剖学复发率为 19.5%，再治疗率为 11.0%（平均随访时间：22.9 个月）。膀胱膨出是最常见的复发部位（17.1%）。保留子宫组（n=66）的年龄更小，产次更少，3 至 4 级膀胱膨出和子宫脱垂的比例也低于同时行子宫切除术组（n=16）。保留子宫组的手术时间更短（99.4 分钟比 153.7 分钟，P=0.002），解剖学复发率更低（11.5%比 45.5%，P=0.039），这一差异在 PSM 前后均存在。既往盆腔器官脱垂手术（风险比 3.14）和同时行子宫切除术（风险比 4.08）是解剖学复发的危险因素。最常见的不良事件是臀部疼痛（14.6%），4 周内可自行缓解。
SSLF 是一种使用原生组织进行盆腔重建的有效手术方法。与同时行子宫切除术相比，保留子宫的 SSLF 可降低解剖学复发率。
