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腹腔镜骶骨阴道固定术后2年的中期结局:日本的一项回顾性队列研究

Medium-term outcomes 2 years after laparoscopic sacrocolpopexy: a retrospective cohort study in Japan.

作者信息

Sato Hirotaka, Otsuka Shota, Abe Hirokazu, Tsukada Sachiyuki

机构信息

Department of Urology, Hokusuikai Kinen Hospital, Ibaraki, Japan.

Department of Urology, Kameda Medical Center, Chiba, Japan.

出版信息

J Obstet Gynaecol. 2022 Oct;42(7):3336-3341. doi: 10.1080/01443615.2022.2125293. Epub 2022 Sep 23.

Abstract

This study was performed to investigate medium-term outcomes and reoperation rates after laparoscopic sacrocolpopexy (LSC). We examined 119 patients undergoing LSC for symptomatic pelvic organ prolapse (POP). The primary outcomes were subjective failure and anatomical failure at 2 years; a score ≥ 2 on question 3 of the PFDI-20 was considered to indicate subjective failure. POP-Q stage 2 or higher in any compartment was considered to indicate anatomical failure. Secondary outcomes were reoperations for POP recurrence, mesh-related complications, and stress urinary incontinence (SUI). The rates of subjective failure and anatomical failure were 4.2% ( = 5) and 9.2% ( = 11), respectively. Reoperations were needed in 13.4% ( = 16) of patients, including SUI with tape procedure in 7.5% ( = 9), POP recurrence in 4.2% ( = 5), and mesh-related complications in 1.6% ( = 2). The subjective failure rate at 2 years after LSC was acceptably low.Impact Statement Laparoscopic sacrocolpopexy (LSC) has clinical efficacy equivalent to open sacrocolpopexy, and there is evidence that LSC involves less blood loss and shorter length of hospital stay. However, there is still insufficient evidence to assess medium-term outcomes after LSC in Japan. The findings of this study showed excellent medium-term rates of subjective failure (4.2%) and anatomical failure (8.4%) after LSC. We demonstrated that patients with persistent postoperative vaginal bulge (subjective failure) also had no improvement in postoperative urinary and colorectal symptoms. Our cohort had low rates of reoperation (13.4%) after LSC. The most common reoperations were for stress urinary incontinence (SUI) (7.5%), followed by pelvic organ prolapse (POP) recurrence (4.2%) and mesh-related complications (1.6%). This study showed that LSC is a safe and effective treatment for POP. Comparative evaluation of anatomical outcomes and the patient's condition is required to understand the extent to which LSC positively impacts a woman's pelvic floor-related quality of life.

摘要

本研究旨在调查腹腔镜骶骨阴道固定术(LSC)后的中期疗效和再次手术率。我们检查了119例因症状性盆腔器官脱垂(POP)接受LSC的患者。主要结局指标为术后2年的主观失败和解剖学失败;PFDI-20问卷第3题得分≥2分被认为提示主观失败。任何区域的POP-Q分期达到2期或更高被认为提示解剖学失败。次要结局指标为因POP复发、网片相关并发症及压力性尿失禁(SUI)而进行的再次手术。主观失败率和解剖学失败率分别为4.2%(n = 5)和9.2%(n = 11)。13.4%(n = 16)的患者需要再次手术,其中因SUI行吊带手术的占7.5%(n = 9),POP复发的占4.2%(n = 5),网片相关并发症的占1.6%(n = 2)。LSC术后2年的主观失败率较低,在可接受范围内。影响声明腹腔镜骶骨阴道固定术(LSC)的临床疗效与开放性骶骨阴道固定术相当,且有证据表明LSC术中失血更少、住院时间更短。然而,在日本,评估LSC术后中期疗效的证据仍不足。本研究结果显示,LSC术后中期主观失败率(4.2%)和解剖学失败率(8.4%)均良好。我们证明,术后持续性阴道膨出(主观失败)的患者术后泌尿和结直肠症状也无改善。我们队列中LSC术后再次手术率较低(13.4%)。最常见的再次手术原因是压力性尿失禁(SUI)(7.5%),其次是盆腔器官脱垂(POP)复发(4.2%)和网片相关并发症(1.6%)。本研究表明,LSC是治疗POP的一种安全有效的方法。需要对解剖学结局和患者情况进行比较评估,以了解LSC对女性盆底相关生活质量产生积极影响的程度。

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