Wang Qi, Wu Nengxiu, Li Ying, Lin Chaoqin, Xu Ying, Chen Xianjing
Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.
J Obstet Gynaecol Res. 2023 Apr;49(4):1273-1282. doi: 10.1111/jog.15574. Epub 2023 Feb 3.
The objective of this study was to evaluate the outcomes of the Manchester procedure (MP) with or without concomitant high uterosacral ligament suspension (HUSLS) for treating uterine prolapse. The primary outcomes were to compare the two methods for differences in perioperative complications and recurrence rates, and to explore whether MP combined with concomitant HUSLS is beneficial in reducing recurrence rates.
A total of 98 uterine prolapse patients underwent MP or MP-HUSLS during the study period. Demographic data, perioperative, and follow-up outcomes were analyzed retrospectively. Univariate and multivariate cox proportional hazards regression analysis was used to explore the effect of surgical methods on recurrence.
The MP-HUSLS group had a higher degree of apical compartment prolapse before the operation, but the pelvic organ prolapse quantification (POP-Q) values of points Ba and C in the MP-HUSLS group improved significantly compared with the MP group (p < 0.05). The operation time in the MP group was shorter than that in the MP-HUSLS group. There were no differences in baseline characteristics or perioperative complications between the two groups. Twelve patients had subjective recurrence during follow-up, although 20 developed anatomical recurrence. After controlling for confounding factors, the MP group had a higher risk of recurrence in the anterior compartment than the MP-HUSLS (adjusted hazard ratio: 4.191, confidence interval: 1.195-14.701, p = 0.025). There was no significant difference in the recurrence rate of the two groups' total, apical, and posterior compartments.
Compared with MP, MP-HUSLS seems more effective in treating uterine prolapse, with a higher location of the points C and Ba. However, further studies with large samples and long follow-up times need to confirm this result.
本研究的目的是评估曼彻斯特手术（MP）联合或不联合高位骶子宫韧带悬吊术（HUSLS）治疗子宫脱垂的效果。主要结果是比较两种方法在围手术期并发症和复发率方面的差异，并探讨MP联合HUSLS是否有助于降低复发率。
在研究期间，共有98例子宫脱垂患者接受了MP或MP-HUSLS治疗。对人口统计学数据、围手术期和随访结果进行回顾性分析。采用单因素和多因素cox比例风险回归分析来探讨手术方法对复发的影响。
MP-HUSLS组术前顶端盆腔脏器脱垂程度较高，但与MP组相比，MP-HUSLS组Ba点和C点的盆腔器官脱垂定量（POP-Q）值有显著改善（p<0.05）。MP组的手术时间比MP-HUSLS组短。两组的基线特征或围手术期并发症无差异。随访期间有12例患者出现主观复发，尽管有20例出现解剖学复发。在控制混杂因素后，MP组前盆腔复发风险高于MP-HUSLS组（调整后风险比：4.191，置信区间：1.195-14.701，p=0.025）。两组总盆腔、顶端盆腔和后盆腔的复发率无显著差异。
与MP相比，MP-HUSLS在治疗子宫脱垂方面似乎更有效，C点和Ba点的位置更高。然而，需要进一步的大样本、长时间随访研究来证实这一结果。
