Yang Yingying, Li Zhen, Si Keyi, Dai Qingqiang, Qiao Yingying, Li Dazhuang, Zhang Li, Wu Fan, He Jia, Wu Guizhu
Clinical Research Unit (Drs. Yang and Z. Li), Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China.
Department of Military Health Statistics (Dr. Si), Naval Medical University, Shanghai, China.
J Minim Invasive Gynecol. 2023 Oct;30(10):833-840.e2. doi: 10.1016/j.jmig.2023.06.011. Epub 2023 Jun 25.
To evaluate the clinical benefits of laparoscopic pectopexy vs laparoscopic sacrocolpopexy in women with pelvic organ prolapse (POP).
Prospective cohort study.
A tertiary hospital.
We included 203 patients with POP.
Laparoscopic pectopexy or laparoscopic sacrocolpopexy.
Anatomic effectiveness was measured using the POP Quantification system, both before and after operation. Functional recovery effectiveness was evaluated using complications and recurrence rates within 1 year. Quality of life was assessed by the Pelvic Floor Distress Inventory-20 and Incontinence Quality of Life questionnaires at enrollment and postoperative months 3, 6, and 12. Comparisons between groups were performed using t test, chi-square test, and mixed-effects model with repeated measures. The analysis included 203 eligible patients (sacrocolpopexy, 101; pectopexy, 102). The proportion of robotic-assisted surgeries was lower in the pectopexy group than in the sacrocolpopexy group (15.7% vs 41.6%, p <.001). The average operation time of pectopexy was shorter than that of sacrocolpopexy (174.2 vs 187.7 minutes) with a mean difference of 13.5 minutes (95% confidence interval, 3.9-23.0; p = .006). Differences of intraoperative blood loss, length of hospital stay, and postoperative 7-day complications between groups were not significant. Anatomic successes were obtained in both groups with similar improvement in POP Quantification scores. The rate of urinary symptoms recurrence was higher in the pectopexy group (13.7%) than in the sacrocolpopexy group (5.0%) at the 1-year follow-up (odds ratio, 3.1; 95% confidence interval, 1.1-8.8, p = .032). The Pelvic Floor Distress Inventory-20 and Incontinence Quality of Life scores were better improved at postoperative months 3, 6, and 12 for laparoscopic pectopexy than for sacrocolpopexy.
Laparoscopic pectopexy revealed comparable anatomic success, shorter operation time, and better improvement in quality of life scores of prolapse, colorectal-anal, and urinary symptoms at 1-year follow-up, possibly being an alternative when sacrocolpopexy is not practicable. However, clinicians should pay more attention to the recurrence of urinary symptoms after pectopexy.
评估腹腔镜耻骨后固定术与腹腔镜骶骨阴道固定术对盆腔器官脱垂（POP）女性患者的临床疗效。
前瞻性队列研究。
一家三级医院。
纳入203例盆腔器官脱垂患者。
腹腔镜耻骨后固定术或腹腔镜骶骨阴道固定术。
术前及术后使用盆腔器官脱垂定量系统测量解剖学疗效。通过1年内的并发症和复发率评估功能恢复效果。在入组时以及术后3、6和12个月，采用盆底困扰量表-20和尿失禁生活质量问卷评估生活质量。组间比较采用t检验、卡方检验以及重复测量的混合效应模型。分析纳入203例符合条件的患者（骶骨阴道固定术组101例；耻骨后固定术组102例）。耻骨后固定术组机器人辅助手术的比例低于骶骨阴道固定术组（15.7%对41.6%，p<0.001）。耻骨后固定术的平均手术时间短于骶骨阴道固定术（分别为174.2分钟和187.7分钟），平均差值为13.5分钟（95%置信区间为3.9 - 23.0；p = 0.006）。两组间术中失血量、住院时间以及术后7天并发症的差异无统计学意义。两组均取得了解剖学成功，盆腔器官脱垂定量评分的改善情况相似。在1年随访时，耻骨后固定术组尿路症状复发率（13.7%）高于骶骨阴道固定术组（5.0%）（优势比为3.1；95%置信区间为1.1 - 8.8，p = 0.032）。在术后3、6和12个月，腹腔镜耻骨后固定术组的盆底困扰量表-20和尿失禁生活质量评分改善情况优于骶骨阴道固定术组。
腹腔镜耻骨后固定术在解剖学疗效方面相当，手术时间较短，并在1年随访时脱垂、结直肠-肛门及尿路症状的生活质量评分改善更好，在骶骨阴道固定术不可行时可能是一种替代方案。然而，临床医生应更关注耻骨后固定术后尿路症状的复发情况。
