Zhang Penghui, Du Weijie, Guo Gang, Yuan Meijuan, Wei Jun
Zhejiang Chinese Medical University - Hangzhou, China.
Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University, Shulan International Medical College, Department of Gynecology - Hangzhou, China.
Rev Assoc Med Bras (1992). 2024 Dec 2;70(12):e20240849. doi: 10.1590/1806-9282.20240849. eCollection 2024.
Pelvic organ prolapse affects women's quality of life through symptoms such as vaginal laxity, urinary incontinence, defecation and sexual dysfunction, and pelvic pain. Given the challenges in managing recurrent cases, understanding risk factors and the effect of surgical choices on recurrence is vital for guiding clinical decisions. This study explores how uterine preservation influences postoperative recurrence and develops predictive models to aid in assessing recurrence risk.
A total of 87 patients diagnosed with pelvic organ prolapse who underwent laparoscopic sacral fixation were included. Patients were classified into two groups based on the occurrence of pelvic organ prolapse recurrence within 3 years post-surgery (recurrence: n=22; no recurrence: n=65). Follow-up over 3 years was recorded. Factors including age, body mass index, birth order, occupation, and uterus preservation during surgery were evaluated. The relationship between pelvic floor muscle strength and pelvic organ prolapse recurrence was also examined. Logistic regression analysis assessed the correlation between pelvic organ prolapse recurrence and levels of serum elastase inhibitor and osteopontin.
In a follow-up of 87 patients with pelvic organ prolapse, 22 experienced recurrences within 3 years, marking a 25.29% recurrence rate. Multivariate analysis identified older age, higher parity, and sustained contraction of type II muscle fibers as independent risk factors for recurrence (all p<0.05). Lower systolic blood pressure in type I and II muscle fibers was associated with decreased serum elastase inhibitor and osteopontin levels, increasing pelvic organ prolapse recurrence risk. Logistic regression identified age, multiple deliveries, and low systolic pressure in type II muscle fibers as independent recurrence factors. The constructed nomogram risk prediction model, incorporating these factors, showed good discrimination ability with an area under the receiver operating characteristic curve of 0.891 (95%CI 0.871, 0.921), indicating accurate predictions and high net benefit.
Factors such as age, birth order, uterine preservation, and pelvic floor muscle strength impact postoperative pelvic organ prolapse recurrence. Older age, a higher number of deliveries, and reduced systolic pressure of class II muscle fibers are independent risk factors for pelvic organ prolapse recurrence after surgery.
盆腔器官脱垂通过阴道松弛、尿失禁、排便及性功能障碍和盆腔疼痛等症状影响女性生活质量。鉴于复发病例管理方面的挑战，了解风险因素及手术选择对复发的影响对于指导临床决策至关重要。本研究探讨保留子宫如何影响术后复发，并建立预测模型以帮助评估复发风险。
共纳入87例诊断为盆腔器官脱垂并接受腹腔镜骶骨固定术的患者。根据术后3年内盆腔器官脱垂复发情况将患者分为两组（复发组：n = 22；未复发组：n = 65）。记录3年的随访情况。评估包括年龄、体重指数、产次、职业及手术中子宫保留情况等因素。还检查了盆底肌肉力量与盆腔器官脱垂复发之间的关系。逻辑回归分析评估盆腔器官脱垂复发与血清弹性蛋白酶抑制剂和骨桥蛋白水平之间的相关性。
在87例盆腔器官脱垂患者的随访中，22例在3年内复发，复发率为25.29%。多因素分析确定年龄较大、产次较高及Ⅱ型肌纤维持续收缩是复发的独立危险因素（均p < 0.05）。Ⅰ型和Ⅱ型肌纤维收缩压较低与血清弹性蛋白酶抑制剂和骨桥蛋白水平降低相关，增加盆腔器官脱垂复发风险。逻辑回归确定年龄、多次分娩及Ⅱ型肌纤维收缩压低为独立复发因素。纳入这些因素构建的列线图风险预测模型显示出良好的区分能力，受试者操作特征曲线下面积为0.891（95%CI 0.871, 0.921），表明预测准确且净效益高。
年龄、产次、子宫保留情况及盆底肌肉力量等因素影响术后盆腔器官脱垂复发。年龄较大、分娩次数较多及Ⅱ类肌纤维收缩压降低是术后盆腔器官脱垂复发的独立危险因素。
