Department of Gynecology, Gynecologic Oncology and Gynecologic Endocrinology, Medical University of Gdańsk, Smoluchowskiego 17, 80-214, Gdańsk, Poland.
2nd Department of Gynecology, Medical University of Lublin, Lublin, Poland.
Int Urogynecol J. 2022 Jan;33(1):31-46. doi: 10.1007/s00192-021-04907-7. Epub 2021 Aug 18.
The aims were to review the literature from the last two decades and analyze treatment efficacy and findings of the studies on colpocleisis.
A systematic search was conducted within the MEDLINE/PubMed and ClinicalTrials.gov databases, using the following keywords: pelvic organ prolapse (POP), colpocleisis, obliterative, and LeFort. All English full-text prospective and retrospective observational and interventional studies were included. Anatomical and subjective success, surgical techniques, concomitant procedures, complication rates, anesthesia methods, and decision regret were analyzed.
A total of 237 papers were identified and 49 met the inclusion criteria. Mean patient age was 69.0 ± 8.0 to 84 ± 3.1. Over 90.2% of patients undergoing colpocleisis were diagnosed with POP stage ≥ 3. The follow-up ranged from 30 days to a median of 5 years. Anatomical success, defined as POP-Q stage ≤ 1 and no prolapse beyond the hymen, was achieved in 62.5 to 100% and 87.5 to 100% of all patients respectively. Subjective success ranged from 88% to 100%. Regret over the loss of coital ability ranged from 0% in many studies to 12.9%, general decision regret from 0% to 13.8%. After concomitant midurethral sling surgery, 86.8% to 94% of all patients were continent, with a 0-14% sling revision rate due to urinary retention. Urinary tract infection was the most common postoperative complication (4.3 to 9% confirmed with urine culture, 34.7% based on symptom definition). Bowel (0 to 2.7%) and urinary tract (0 to 9.1%) injuries were the consequences of concomitant procedures. The mortality rates were up to 1.3%.
Colpocleisis is a heterogeneous procedure, characterized by high subjective and objective success, low coital ability regret, and a low risk of complications.
目的是回顾过去二十年的文献，分析阴道封闭术的治疗效果和研究结果。
在 MEDLINE/PubMed 和 ClinicalTrials.gov 数据库中进行了系统搜索，使用了以下关键词：盆腔器官脱垂（POP）、阴道封闭术、闭塞、和 LeFort。所有英语全文前瞻性和回顾性观察性和干预性研究均被纳入。分析了解剖学和主观成功率、手术技术、伴随手术、并发症发生率、麻醉方法和决策后悔。
共确定了 237 篇论文，其中 49 篇符合纳入标准。患者平均年龄为 69.0±8.0 至 84±3.1 岁。90.2%以上行阴道封闭术的患者被诊断为 POP 分期≥3 期。随访时间从 30 天到中位数 5 年不等。解剖学成功率定义为 POP-Q 分期≤1 且处女膜外无脱垂，所有患者的成功率分别为 62.5%至 100%和 87.5%至 100%。主观成功率从 88%到 100%不等。对丧失性交能力的遗憾程度从许多研究中的 0%到 12.9%不等，对总体决策的遗憾程度从 0%到 13.8%不等。在同时进行的中尿道吊带手术后，所有患者中有 86.8%至 94%的患者具有控尿能力，由于尿潴留，吊带修正率为 0-14%。尿路感染是最常见的术后并发症（4.3%至 9%经尿液培养证实，34.7%基于症状定义）。肠道（0 至 2.7%）和尿路（0 至 9.1%）损伤是伴随手术的后果。死亡率高达 1.3%。
阴道封闭术是一种异质性手术，具有高主观和客观成功率、低性交能力后悔率和低并发症风险的特点。
