Zhang Yinghui, Wang Wenying, Lu Yongxian, Shen Wenjie, Niu Ke
The Fourth Medical Center, Senior Department of Obstetrics & Gynecology, the Seventh Medical Center of PLA General Hospital, Beijing, China.
Gland Surg. 2022 Jun;11(6):992-1002. doi: 10.21037/gs-22-261.
The surgical treatment of post-hysterectomy vaginal vault prolapse (PHVP) has been reported in several clinical studies, but mostly are short-term studies. This study aims to explore the mid-term efficacy of surgical treatments for PHVP.
A total of 138 PHVP patients underwent surgery from January 2005 to January 2020 at the Fourth Medical Center of PLA General Hospital, Beijing. The clinical data of 119 patients who completed follow-up were retrospectively analyzed. Both groups of patients are diagnosed Pelvic Organ Prolapse Quantification system (POP-Q) III-IV stage of prolapse, with obvious prolapse-related symptoms and requiring surgical treatment. Among them, pelvic floor reconstruction surgery (RPS) was performed in patients who wanted to retain vaginal function and colpocleisis were used for frail patients who cannot tolerate RPS. We used the POP-Q scores for the objective efficacy evaluation, and use the Pelvic Floor Distress Inventory-Short Form 20 (PFDI-20) and Pelvic Floor Impact Questionnaire-7 (PFIQ-7) to evaluate the subjective symptom during follow up. Among them, 61 patients underwent pelvic floor RPS (Group R), and 58 received colpocleisis (Group C).
The surgeries in both groups were successfully completed, the median follow-up time after surgery was 4.3 years (0.25-13 years) and 5.3 years (0.33-15 years), respectively; the overall surgical success rate was 86.9% (53/61) and 100% (58/58), respectively; the subjective satisfaction rate was 90.2% (55/61) and 91.4% (53/58), respectively; and the PFDI-20 and PFIQ-7 scores in both groups were significantly improved compared with the preoperative levels (P<0.05). In Group R, 6 cases (9.8%, 6/61) were dissatisfied after surgery; in Group C, 5 cases (8.6%, 5/58) were dissatisfied after surgery.
Reconstructive surgery and colpocleisis have a good mid-term effect on PHVP, with good outcome and few complications. The surgeon is expected to ascertain an appropriate surgical procedure based on the characteristics of the patient, the degree and the location of prolapse, in order to achieve the best surgical efficacy and minimize the damage.
多项临床研究报道了子宫切除术后阴道穹窿脱垂（PHVP）的手术治疗，但大多为短期研究。本研究旨在探讨PHVP手术治疗的中期疗效。
2005年1月至2020年1月，解放军总医院第四医学中心共138例PHVP患者接受手术。对119例完成随访的患者临床资料进行回顾性分析。两组患者均诊断为盆腔器官脱垂定量系统（POP-Q）III-IV度脱垂，有明显的脱垂相关症状且需手术治疗。其中，想保留阴道功能的患者行盆底重建手术（RPS），不能耐受RPS的体弱患者行阴道封闭术。我们采用POP-Q评分进行客观疗效评估，并在随访期间使用盆底困扰量表简表20（PFDI-20）和盆底影响问卷7（PFIQ-7）评估主观症状。其中，61例行盆底RPS（R组），58例行阴道封闭术（C组）。
两组手术均顺利完成，术后中位随访时间分别为4.3年（0.25 - 13年）和5.3年（0.33 - 15年）；总体手术成功率分别为86.9%（53/61）和100%（58/58）；主观满意率分别为90.2%（55/61）和91.4%（53/58）；两组PFDI-20和PFIQ-7评分均较术前显著改善（P<0.05）。R组术后6例（9.8%，6/61）不满意；C组术后5例（8.6%，5/58）不满意。
重建手术和阴道封闭术对PHVP有良好的中期效果，疗效好且并发症少。期望外科医生根据患者特点、脱垂程度和部位确定合适的手术方式，以达到最佳手术疗效并减少损伤。
