Guan Yiqi, Zhang Kun, Han Jinsong, Yao Ying, Wang Yiting, Yang Junfang
Department of Obstetrics and Gynecology, Peking University Third Hospital, No.49 North Garden Street, 100191, Beijing, China.
Int Urogynecol J. 2023 Oct;34(10):2501-2506. doi: 10.1007/s00192-023-05552-y. Epub 2023 May 24.
The objective was to retrospectively analyze the midterm efficacy of laparoscopic high uterosacral ligament suspension (HUS) and sacrocolpopexy (SC) in the treatment of moderate to severe apical prolapse.
Patients who underwent laparoscopic HUS and SC in our center from 2013 to 2019 with follow-ups were included, consisting of laparoscopic HUS (group A, n=72) or SC (mesh added, group B, n=54). The general data of patients, pelvic organ prolapse quantitative examination (POP-Q) score, Pelvic Floor Distress Inventory short form 20 score (PFDI-20) before and after operation, perioperative conditions, Patient Global Impression of Improvement (PGI-I), and postoperative complications were collected for statistical analysis and comparison between groups.
There was no statistical difference in preoperative data between groups. The median follow-up time was 48 months. The objective recurrence rate of group A was higher than that of group B, without statistical significance. One patient in group B had a second operation owing to recurrence. The exposure rate of mesh in group B was 3.70%. There was no significant difference in deviation of POP-Q and PFDI-20 pre- and post-operation. The proportion of new defecation abnormalities in group A was lower. The total hospitalization expenses and surgical consumables in group B were significantly higher than those in group A.
The midterm curative effect of laparoscopic HUS is similar to that of SC in the treatment of moderate to severe apical prolapse. The former has the advantages of less intraoperative blood loss, shorter postoperative hospital stay, lower cost, fewer new defecation abnormalities, and there were no complications related to mesh.
目的是回顾性分析腹腔镜高位子宫骶韧带悬吊术（HUS）和骶骨阴道固定术（SC）治疗中重度顶端脱垂的中期疗效。
纳入2013年至2019年在本中心接受腹腔镜HUS和SC手术并进行随访的患者，包括腹腔镜HUS组（A组，n = 72）或SC组（加用网片，B组，n = 54）。收集患者的一般资料、盆腔器官脱垂定量检查（POP-Q）评分、手术前后盆底功能障碍问卷简表20评分（PFDI-20）、围手术期情况、患者整体改善印象（PGI-I）及术后并发症，进行统计学分析并比较两组情况。
两组术前数据无统计学差异。中位随访时间为48个月。A组的客观复发率高于B组，但无统计学意义。B组有1例患者因复发接受了二次手术。B组网片暴露率为3.70%。POP-Q和PFDI-20手术前后的偏差无显著差异。A组新出现排便异常的比例较低。B组的总住院费用和手术耗材费用显著高于A组。
腹腔镜HUS治疗中重度顶端脱垂的中期疗效与SC相似。前者具有术中出血少、术后住院时间短、成本低、新出现排便异常少等优点，且无与网片相关的并发症。
