Shahid Usama, Chen Zhouran, Maher Christopher
Royal Brisbane and Women's Hospital, Brisbane, Australia.
James Cook University, Brisbane City, QLD, 4000, Australia.
Int Urogynecol J. 2024 Nov;35(11):2107-2123. doi: 10.1007/s00192-024-05922-0. Epub 2024 Oct 15.
Sacrocolpopexy (SCP) is an established surgical procedure for apical vaginal vault prolapse. There remains significant variation amongst surgeons in both the surgical steps and concomitant surgeries utilised when undertaking an SCP.
This review article is aimed at summarising the evidence and providing a detailed update of SCP in modern practice, reviewing contemporary evidence behind its indications, efficacy, outcomes, surgical steps, and complications.
Sacrocolpopexy remains the gold standard for post-hysterectomy apical prolapse based on good long-term outcomes, patient satisfaction and low complication rates. SCP with concomitant total hysterectomy is not recommended owing to high rates of mesh exposure. The laparoscopic approach remains the preferred option in terms of low morbidity, quicker recovery and lower cost than alternative access options. For optimal outcomes an SCP should be performed with monofilament mesh, using absorbable sutures and with a paravaginal repair for cystocele.
Although SCP has become increasingly utilised for apical prolapse, its established efficacy regarding anatomical outcomes, patient satisfaction, and complications is in the context of post-hysterectomy prolapse. SCP with concomitant total hysterectomy has higher rates of mesh exposure. The efficacy and safety of SCP with sub-total hysterectomy or hysteropexy have not been clearly established and require further assessment through well-designed, rigorous randomised controlled trials.
骶棘韧带固定术（SCP）是治疗顶端阴道穹窿脱垂的一种成熟手术方法。在进行骶棘韧带固定术时，外科医生在手术步骤和同期手术方面仍存在显著差异。
这篇综述文章旨在总结相关证据，并详细介绍现代临床实践中骶棘韧带固定术的最新情况，回顾其适应证、疗效、结局、手术步骤及并发症背后的当代证据。
基于良好的长期疗效、患者满意度及低并发症发生率，骶棘韧带固定术仍是子宫切除术后顶端脱垂的金标准。不建议同时进行全子宫切除术的骶棘韧带固定术，因为网片暴露率较高。与其他手术入路相比，腹腔镜手术在低发病率、更快恢复及更低成本方面仍是首选。为获得最佳疗效，骶棘韧带固定术应使用单丝网片、可吸收缝线，并同时进行膀胱膨出的阴道旁修补术。
尽管骶棘韧带固定术越来越多地用于治疗顶端脱垂，但其在解剖学结局、患者满意度及并发症方面已证实的疗效是在子宫切除术后脱垂的背景下。同时进行全子宫切除术的骶棘韧带固定术网片暴露率较高。次全子宫切除术或子宫固定术联合骶棘韧带固定术的疗效和安全性尚未明确确立，需要通过设计良好、严格的随机对照试验进一步评估。
