From the Georgetown University School of Medicine/MedStar Health, Washington, DC.
Stanford University School of Medicine, Stanford, CA.
Female Pelvic Med Reconstr Surg. 2022 Jun 1;28(6):e215-e221. doi: 10.1097/SPV.0000000000001188. Epub 2022 May 17.
Data on long-term mesh hysteropexy outcomes are limited. This study provides 7-year data from the original VAULT (Vaginal and Laparoscopic Mesh Hysteropexy for Uterovaginal Prolapse Trial) study.
The aim of this study was to compare long-term outcomes and success for laparoscopic sacral hysteropexy (LSHP) and vaginal mesh hysteropexy (VMHP).
This multicenter, prospective parallel cohort was an extension to the initial VAULT study. Subjects were contacted, and informed consent was obtained. We collected baseline demographics and the latest Pelvic Organ Prolapse-Quantification examination data from chart review and conducted telephone interviews to update demographic information and collect Pelvic Floor Distress Inventory Short-Form, Patient Global Impression of Improvement, prolapse reoperation/pessary use, and complications. Surgical success was defined as no bulge symptoms, satisfaction score of "very much better" or "much better," and no reoperation/pessary use.
Five of 8 original sites enrolled 53 subjects (LSHP n = 34 and VMHP n = 19). The LSHP group was younger (67 vs 74, P < 0.01), but there were no differences in parity, body mass index, menopause, race, insurance, tobacco use, or Charlson Comorbidity Index. The median subjective follow-up was 7.3 ± 0.9 years. Composite success was 82% LSHP versus 74% VMHP. Pelvic Floor Distress Inventory Short-Form composite scores were similar at baseline and improved for both groups (P < 0.01) with lower bother observed in the LSHP group (20.8 vs 43.8, P = 0.01). There were no differences in complications.
Over 7 years after surgery, LSHP and VMHP have high success, low retreatment, and low complication rates that did not differ between groups. Although there is a trend toward better anatomic support in the LSHP group, these findings were not significant and we are underpowered to detect a difference.
关于长期网片悬吊术结果的数据有限。本研究提供了原始 VAULT（阴道和腹腔镜网片子宫悬吊术治疗子宫阴道脱垂试验）研究的 7 年数据。
本研究旨在比较腹腔镜骶骨悬吊术（LSHP）和阴道网片悬吊术（VMHP）的长期结果和成功率。
这是一项多中心、前瞻性平行队列研究，是初始 VAULT 研究的延伸。通过病历回顾收集基线人口统计学资料和最新的盆腔器官脱垂定量检查数据，并进行电话访谈以更新人口统计学资料，收集盆底窘迫量表简表、患者总体改善印象、脱垂再手术/子宫托使用和并发症。手术成功定义为无膨出症状、满意度评分“非常好”或“好得多”、无再手术/子宫托使用。
5 个原研究中心中的 5 个共纳入 53 名受试者（LSHP 组 34 名，VMHP 组 19 名）。LSHP 组更年轻（67 岁 vs 74 岁，P < 0.01），但在产次、体重指数、绝经、种族、保险、吸烟和 Charlson 合并症指数方面无差异。中位主观随访时间为 7.3 ± 0.9 年。LSHP 组复合成功率为 82%，VMHP 组为 74%。两组盆底窘迫量表简表评分均在基线时相似，并均有所改善（P < 0.01），LSHP 组的困扰程度较低（20.8 分 vs 43.8 分，P = 0.01）。两组并发症无差异。
手术 7 年后，LSHP 和 VMHP 的成功率高、复发率低、并发症发生率低，且两组间无差异。虽然 LSHP 组在解剖学支持方面有更好的趋势，但这些发现没有统计学意义，而且我们的检测能力不足以发现差异。
