Department of Urology, Wake Forest Baptist Health, Winston-Salem, NC, USA.
Department of Urology, 140 Charlois Blvd, Winston-Salem, NC, 27103, USA.
Int Urogynecol J. 2021 Jun;32(6):1555-1563. doi: 10.1007/s00192-020-04641-6. Epub 2021 Jan 13.
The posterior approach to sacrospinous hysteropexy has been well studied but little is known about the anterior approach. This study assessed the efficacy and complications of an anterior approach to sacrospinous hysteropexy compared to hysterectomy with apical repair. We hypothesized that anterior sacrospinous hysteropexy has similar efficacy and fewer complications.
This retrospective cohort study compared patients who underwent native-tissue anterior sacrospinous hysteropexy (cases) with those who underwent hysterectomy with apical repair (controls). Composite success was defined as (1) leading edge of prolapse not beyond the hymen and apex not descended > 1/3 total vaginal length; (2) no vaginal bulge symptoms; (3) no prolapse retreatment. Descriptive and bivariate statistics were performed as well as a Cox regression analysis for time to failure.
Fifty cases and 97 controls were compared. The median follow-up time was 7.6 months. Operative time was shorter in the hysteropexy group (110.7 vs. 155.9 min, p < 0.001). The composite success was 92% for both cases and controls (p = 1.000) with no difference in time to surgical failure (p = 0.183). There were no serious intraoperative complications in the hysteropexy group and six in the control group (3 transfusions, 1 conversion to laparotomy, 1 ureteral injury, 1 cystotomy; p = 0.101). There was no difference in the number of postoperative complications (22.0% vs. 30.9%, p = 0.203).
For primary uterine prolapse, anterior sacrospinous hysteropexy has similar short-term efficacy compared to hysterectomy with apical repair with shorter operative time and a trend towards fewer serious complications.
经后路骶棘韧带固定术已有大量研究，但对前路方法知之甚少。本研究评估了前路骶棘韧带固定术与子宫切除术联合顶端修复术治疗子宫脱垂的疗效和并发症。我们假设前路骶棘韧带固定术具有相似的疗效和更少的并发症。
本回顾性队列研究比较了行天然组织前路骶棘韧带固定术（病例组）和行子宫切除术联合顶端修复术（对照组）的患者。复合成功率定义为：（1）脱垂前缘不超过处女膜，顶点未下降超过阴道总长度的 1/3；（2）无阴道膨出症状；（3）无脱垂复发。采用描述性和双变量统计以及 Cox 回归分析失败时间。
比较了 50 例病例和 97 例对照。中位随访时间为 7.6 个月。固定组手术时间更短（110.7 分钟 vs. 155.9 分钟，p<0.001）。两组的复合成功率均为 92%（病例组和对照组，p=1.000），手术失败时间无差异（p=0.183）。固定组无严重术中并发症，对照组有 6 例（3 例输血，1 例转为剖腹手术，1 例输尿管损伤，1 例膀胱切开术；p=0.101）。术后并发症的数量无差异（22.0% vs. 30.9%，p=0.203）。
对于原发性子宫脱垂，前路骶棘韧带固定术与子宫切除术联合顶端修复术具有相似的短期疗效，手术时间更短，严重并发症的发生率有减少的趋势。
