Bushra Maham, Anglim Breffini, Al-Janabi Ahmad, Lovatsis Danny, Alarab May
Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON.
Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON.
J Obstet Gynaecol Can. 2021 Oct;43(10):1129-1135. doi: 10.1016/j.jogc.2021.04.012. Epub 2021 May 11.
The incidence of post-hysterectomy vault prolapse following native tissue repair has been reported to be as high as 43%. The optimal way to maintain vault support is unknown. Our aim was to evaluate the long-term efficacy of modified McCall culdoplasty during vaginal hysterectomy for symptomatic uterine prolapse in preventing the recurrence of vaginal vault prolapse.
We conducted a retrospective chart review involving 490 patients who underwent vaginal hysterectomy with modified McCall culdoplasty, with or without a concomitant stress incontinence procedure, between January 2008 and December 2018 at Mount Sinai Hospital in Toronto. Data analyzed included patient demographics, preoperative prolapse staging, intraoperative and postoperative complications, and postoperative subjective and objective success rates.
A total of 490 patients underwent vaginal hysterectomy with modified McCall culdoplasty. The mean follow-up period was 2.8 years. The objective success rate of vault support was 97.1%, and the subjective success rate was 94.1%. The total rate of reoperation for recurrence of vault prolapse was 1.0%. The objective cystocele recurrence rate was 8.6%, and 2.4% of these cases required reoperation. The objective rectocele recurrence rate was 4.7%, with 1.2% requiring reoperation. Unilateral ureteric kinking requiring intraoperative release of the McCall suture was recorded for 2.9% of patients. Overall, there was significant improvement in urinary, bowel, and prolapse symptoms post procedure.
This cohort of patients who underwent modified McCall culdoplasty had low rates of vault prolapse recurrence and prolapse symptoms. The modified McCall culdoplasty technique practised at our institution is safe and effective in preventing post-hysterectomy vault prolapse.
据报道，采用自体组织修复后子宫切除术后穹窿脱垂的发生率高达43%。维持穹窿支撑的最佳方法尚不清楚。我们的目的是评估改良麦考尔盆底成形术在阴道子宫切除术中治疗有症状子宫脱垂时预防阴道穹窿脱垂复发的长期疗效。
我们对2008年1月至2018年12月期间在多伦多西奈山医院接受改良麦考尔盆底成形术的490例患者进行了回顾性病历审查，这些患者接受了或未接受同期压力性尿失禁手术。分析的数据包括患者人口统计学、术前脱垂分期、术中及术后并发症，以及术后主观和客观成功率。
共有490例患者接受了改良麦考尔盆底成形术的阴道子宫切除术。平均随访期为2.8年。穹窿支撑的客观成功率为97.1%，主观成功率为94.1%。穹窿脱垂复发的再次手术总率为1.0%。膀胱膨出客观复发率为8.6%，其中2.4%的病例需要再次手术。直肠膨出客观复发率为4.7%，1.2%需要再次手术。2.9%的患者记录有术中需要松解麦考尔缝线的单侧输尿管扭结。总体而言，术后泌尿、肠道和脱垂症状有显著改善。
接受改良麦考尔盆底成形术的这组患者穹窿脱垂复发率和脱垂症状发生率较低。我们机构采用的改良麦考尔盆底成形术技术在预防子宫切除术后穹窿脱垂方面是安全有效的。
