Serati Maurizio, Salvatore Stefano, Torella Marco, Scancarello Chiara, De Rosa Andrea, Ruffolo Alessandro Ferdinando, Caccia Giorgio, Ghezzi Fabio, Papadia Andrea, Baruch Yoav, Braga Andrea
Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy.
Department of Obstetrics and Gynecology, IRCSS San Raffaele Scientific Institute, 21132 Milan, Italy.
J Clin Med. 2023 Mar 28;12(7):2548. doi: 10.3390/jcm12072548.
Although it is known that hysterectomy (HY) alone cannot resolve apical prolapse, vaginal hysterectomy (VH) remains the most common surgical procedure for this issue. In recent years, various procedures for uterine conservation have been proposed to avoid the surgical risks of HY. Furthermore, most women with symptomatic pelvic organ prolapse (POP) prefer uterine conservation in the absence of considerable benefit in uterine removal. In 2017, we proposed a new technique for hysteropexy and anterior vaginal native tissue repair (NTR) in women with cystocele and apical prolapse. The objective of this study is to assess the efficacy and safety of this new procedure after at least 5 years of follow-up. We included only patients with stage II or greater prolapse of the anterior vaginal wall and a concomitant stage II uterine prolapse in accordance with Pelvic Organ Prolapse Quantification (POP-Q) system. A Patient Global Impression of Improvement (PGI-I) score ≤ 2 in addition with the absence of POP symptoms was defined as subjective success. A descensus with a maximum point of less than -1 in any compartment was considered objective cure. A total of 102 patients who fulfilled the inclusion criteria were enrolled. At 60 months follow-up, 90 out of 102 patients (88%) were subjectively cured, whereas 88 out of the 102 (86%) patients were objectively cured. Subjective and objective cure rates persisted during the entire study period. Uni- and multivariate analysis of possible predictive factors associated with recurrence of prolapse showed that only a preoperative point C > 0 cm and BMI ≥ 25 kg/m were risk factors for failure. In conclusion, our study showed that hysteropexy with anterior vaginal native tissue repair may be an effective and safe option for the treatment of anterior vaginal prolapse and concomitant stage II uterine prolapse by at least 5 years of follow-up.
尽管已知单纯子宫切除术（HY）无法解决顶端脱垂问题，但阴道子宫切除术（VH）仍是针对该问题最常见的外科手术。近年来，为避免子宫切除术的手术风险，已提出多种保留子宫的手术方法。此外，大多数有症状的盆腔器官脱垂（POP）女性在子宫切除无显著益处时更倾向于保留子宫。2017年，我们提出了一种针对膀胱膨出和顶端脱垂女性的子宫固定术及阴道前壁自体组织修复（NTR）新技术。本研究的目的是评估至少5年随访后该新手术的疗效和安全性。我们仅纳入了根据盆腔器官脱垂定量（POP-Q）系统诊断为阴道前壁脱垂II度或以上且伴有II度子宫脱垂的患者。患者整体改善印象（PGI-I）评分≤2且无POP症状被定义为主观成功。任何腔室最大点下降小于-1被视为客观治愈。共有102名符合纳入标准的患者入组。在60个月随访时，102名患者中有90名（88%）主观治愈，而102名患者中有88名（86%）客观治愈。主观和客观治愈率在整个研究期间持续存在。对与脱垂复发相关的可能预测因素进行单因素和多因素分析显示，仅术前C点>0 cm和体重指数（BMI）≥25 kg/m²是失败的危险因素。总之，我们的研究表明，至少5年随访结果显示，子宫固定术联合阴道前壁自体组织修复对于治疗阴道前壁脱垂及伴发的II度子宫脱垂可能是一种有效且安全的选择。
