Mao Meng, Fu Hanlin, Wang Qian, Bai Jing, Zhang Ye, Guo Ruixia
Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Maturitas. 2023 Apr;170:58-63. doi: 10.1016/j.maturitas.2023.01.005. Epub 2023 Jan 18.
This study compares the recurrence rate, complication rate and subjective satisfaction with laparoscopic uterosacral suspension with or without hysterectomy.
This retrospective cohort study included 105 patients between June 2014 and December 2019. Recurrent pelvic organ prolapse was defined as any prolapse to or beyond the hymen with straining or needing retreatment. Student's t-test, the Mann-Whitney U test, the chi square test or Fisher's exact test, multivariate Cox proportional hazards regression and Kaplan-Meier survival analysis were used for the data analysis.
Whether the durability of laparoscopic uterosacral suspension surgery is affected by uterine preservation.
60 patients underwent laparoscopic uterosacral suspension with concomitant hysterectomy (Hysterectomy group), and 45 underwent laparoscopic uterosacral hysteropexy (Hysteropexy group). The median (interquartile range) duration of follow-up for all 105 patients was 31 (22.5-47.5) months. The results of multivariate Cox proportional hazards regression showed that no difference was found in the risk of overall recurrence between the hysterectomy and hysteropexy groups (25 % vs. 22 %; HR, 0.37; 95 % CI, 0.14-1.00). Kaplan-Meier survival analysis also demonstrated that there were no significant differences in the overall rates of recurrent prolapse between the two groups (P = 0.30). In addition, the subjective success rates were high in both groups (82 %).
Our study demonstrated equally satisfactory objective and subjective long-term outcomes after laparoscopic uterosacral suspension with or without hysterectomy. Laparoscopic uterosacral hysteropexy can be safely and effectively offered to patients with pelvic organ prolapse who wish to preserve their uterus and do not have contraindications.
本研究比较了行或不行子宫切除术的腹腔镜子宫骶骨固定术的复发率、并发症发生率和主观满意度。
这项回顾性队列研究纳入了2014年6月至2019年12月期间的105例患者。复发性盆腔器官脱垂定义为用力时任何脱垂至处女膜或超过处女膜或需要再次治疗。采用学生t检验、曼-惠特尼U检验、卡方检验或费舍尔精确检验、多变量Cox比例风险回归和Kaplan-Meier生存分析进行数据分析。
腹腔镜子宫骶骨固定术的耐久性是否受子宫保留的影响。
60例患者接受了腹腔镜子宫骶骨固定术并同时行子宫切除术（子宫切除组），45例接受了腹腔镜子宫骶骨悬吊术（悬吊组）。105例患者的中位（四分位间距）随访时间为31（22.5-47.5）个月。多变量Cox比例风险回归结果显示，子宫切除组和悬吊组的总体复发风险无差异（25%对22%；HR，0.37；95%CI，0.14-1.00）。Kaplan-Meier生存分析也表明，两组间复发脱垂的总体发生率无显著差异（P = 0.30）。此外，两组的主观成功率均较高（82%）。
我们的研究表明，行或不行子宫切除术的腹腔镜子宫骶骨固定术在客观和主观长期结局方面同样令人满意。对于希望保留子宫且无禁忌证的盆腔器官脱垂患者，腹腔镜子宫骶骨悬吊术可以安全有效地实施。
