Department of Obstetrics and Gynecology, Koc University School of Medicine, Istanbul, Turkey.
Department of Obstetrics and Gynecology, American Hospital, Tesvikiye, Sisli, Istanbul, Turkey.
Eur J Obstet Gynecol Reprod Biol. 2024 Sep;300:315-326. doi: 10.1016/j.ejogrb.2024.07.029. Epub 2024 Jul 14.
This review aims to consolidate current research on cervical elongation, a common but often overlooked complication in pelvic organ prolapse and hysteropexy procedures. It seeks to define, diagnose, and manage cervical elongation, aiming to establish standardized criteria and strategies to enhance clinical outcomes for this condition.
A comprehensive search of the PubMed/MEDLINE, Cochrane Library, and Web of Science databases was executed utilizing the keywords: "cervical elongation," "long cervix uteri," "Manchester," and "cervical amputation". Data were gathered and organized in an Excel spreadsheet, with the analysis conducted according to each category, methodology, or reference range.
All types of study designs with full-text availability, including randomized controlled trials, cohort studies, case-control studies, case reports, and systematic reviews, were considered for inclusion. Included studies were fully accessible in English and focused on the topic of interest. Exclusions were made for studies addressing cervical elongation not pertinent to pelvic organ prolapse, and publications such as secondary analyses, case reports, literature reviews, and opinion papers.
Out of 108 relevant studies, only 63 defined their inclusion criteria; of these, 57 were utilized for the narrative review and 8 were used in a meta-analysis comparing the Manchester operation with vaginal hysterectomy. Magnetic Resonance Imaging offers the highest sensitivity in measuring cervical elongation, its practical limitations and high cost necessitate the use of the more feasible Pelvic Organ Prolapse Quantification System (POP-Q), particularly effective for stage 2 and 3 prolapse cases. The POP-Q point C emerges as a pivotal marker for identifying cervical elongation, with specific measurements indicating the condition's presence. The Manchester-Fothergill procedure presents a viable management option for isolated cervical elongation, showing fewer complications and comparable recurrence rates to vaginal hysterectomy.
This review highlights the diagnostic and definitional diversity of cervical elongation within populations experiencing pelvic organ prolapse. It emphasizes the critical role of preoperative cervical evaluation, particularly in patients with uterine descensus for selecting the most appropriate surgical intervention.
本综述旨在整合当前有关宫颈延长的研究，这是盆腔器官脱垂和子宫固定术中常见但常被忽视的并发症。本综述旨在定义、诊断和处理宫颈延长，旨在建立该疾病的标准化标准和策略，以改善临床结局。
通过关键词“cervical elongation”、“long cervix uteri”、“Manchester”和“cervical amputation”，对 PubMed/MEDLINE、Cochrane 图书馆和 Web of Science 数据库进行了全面检索。将数据收集并整理到 Excel 电子表格中，根据类别、方法或参考范围对其进行分析。
所有类型的研究设计（包括随机对照试验、队列研究、病例对照研究、病例报告和系统评价）只要全文可获取，且研究内容包含宫颈延长与盆腔器官脱垂相关的研究，均被认为符合纳入标准。排除标准为与盆腔器官脱垂无关的宫颈延长研究，以及二级分析、病例报告、文献综述和观点论文等出版物。
在 108 项相关研究中，仅有 63 项研究定义了其纳入标准；其中 57 项研究用于叙述性综述，8 项研究用于比较曼彻斯特手术与经阴道子宫切除术的荟萃分析。磁共振成像（MRI）在测量宫颈延长方面具有最高的敏感性，但其实用性限制和高成本需要使用更可行的盆腔器官脱垂量化系统（POP-Q），该系统对于 2 期和 3 期脱垂病例特别有效。POP-Q 点 C 是识别宫颈延长的关键标志物，特定的测量值表明存在该情况。曼彻斯特-福瑟吉尔手术（Manchester-Fothergill procedure）是一种可行的治疗孤立性宫颈延长的方法，其并发症较少，复发率与经阴道子宫切除术相当。
本综述强调了在经历盆腔器官脱垂的人群中，宫颈延长在诊断和定义上的多样性。它强调了术前宫颈评估的关键作用，特别是在子宫下降的患者中，以便选择最合适的手术干预措施。
