Department of Gynaecology and Reproductive Medicine, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747 Jena, Germany; Department of Gynaecology, St. Georg Hospital Eisenach, Academic Teaching Hospital of Friedrich-Schiller-University Jena, Eisenach, Germany.
Department of Gynaecology and Reproductive Medicine, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747 Jena, Germany; Department of Traumatology, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747 Jena, Germany.
Eur J Obstet Gynecol Reprod Biol. 2023 Jan;280:144-149. doi: 10.1016/j.ejogrb.2022.11.023. Epub 2022 Nov 24.
Recent findings address the importance of Level III defects with increased genital hiatus being associated with pelvic organ prolapse (POP), correlated with Level I defects and strongly related to POP recurrence. We hypothesised that concomitant perineorrhaphy in POP repair reduces genital hiatus (gh) and increases perineal body (pb), that gh would be larger with number of vaginal deliveries and that patients' QOL was not different comparing sexually active vs inactive patients with overall judgement of cure comparable to the literature at evaluation.
Retrospective observational study including consecutive patients with indications for posterior repair and Level III support between 2016 and 2018. Concomitant perineorrhaphy was indicated due to complaints of wide introitus or genital hiatus of ≥ 3.5 cm. Primary objective was to compare pre- and postoperative gh and pb according to POP-Q. Secondary objectives were preoperative gh and pb values by parity, POMs obtained with P-QOL/D comparing sexually active vs inactive patients, and subjective judgement of cure according to EGGS system.
In n = 121 patients, mean gh value was reduced postoperatively by 29.5 % (31 ± 6 vs 44 ± 10 mm, p < 0.001), mean pb value increased by 25.5 % (47 ± 8 vs 35 ± 8 mm, p < 0.001). Influence of parity on preoperative gh (p = 0.020), but not pb values (p = 0.119) was observed. All P-QOL/D domain scores improved significantly postoperatively without differences seen in sexually active vs inactive patients. EGGS responses indicated partial/full goal achievement in 90 % and cure in 87 %.
In the study cohort, perineorrhaphy as concomitant in POP repair led to Level III support reflected by decreased genital hiatus size. Functional QOL was improved regardless of sexual activity status and the majority of patients reported partial or full cure.
最近的研究结果表明,III 度缺陷伴有增加的生殖器裂孔与盆腔器官脱垂(POP)有关,与 I 度缺陷相关,并与 POP 复发密切相关。我们假设在 POP 修复中同时进行会阴修补术可以减少生殖器裂孔(gh)并增加会阴体(pb),gh 会随着阴道分娩次数的增加而增大,并且患者的生活质量(QOL)在比较活跃和不活跃患者时没有差异,整体治愈率与文献评估相当。
回顾性观察研究,纳入 2016 年至 2018 年间有后修补和 III 度支撑指征的连续患者。由于宽阴道口或生殖器裂孔≥3.5cm 的抱怨,同时进行会阴修补术。主要目的是根据 POP-Q 比较术前和术后 gh 和 pb。次要目标是根据产次比较术前 gh 和 pb 值、使用 P-QOL/D 获得的 POMs、比较活跃和不活跃患者的主观治愈率以及根据 EGGS 系统进行的主观治愈率。
在 n=121 名患者中,gh 值术后平均减少 29.5%(31±6 与 44±10mm,p<0.001),pb 值平均增加 25.5%(47±8 与 35±8mm,p<0.001)。观察到产次对术前 gh(p=0.020)的影响,但对 pb 值(p=0.119)没有影响。所有 P-QOL/D 域评分术后均显著改善,在活跃和不活跃患者之间没有差异。EGGS 反应表明 90%的患者达到部分/完全目标,87%的患者治愈。
在研究队列中,在 POP 修复中同时进行会阴修补术导致 III 度缺陷的支持水平降低,生殖器裂孔大小减小。功能 QOL 得到改善,无论性生活状态如何,大多数患者报告部分或完全治愈。