Giugale Lauren E, Ruppert Kristine M, Muluk Sruthi L, Glass Clark Stephanie M, Bradley Megan S, Wu Jennifer M, Matthews Catherine A
University of Pittsburgh, Pittsburgh, PA.
University of Pittsburgh School of Medicine.
Urogynecology (Phila). 2024 Oct 1;30(10):814-820. doi: 10.1097/SPV.0000000000001530. Epub 2024 May 18.
Limited data exist comparing total laparoscopic hysterectomy (TLH) versus laparoscopic supracervical hysterectomy (LSCH) at the time of minimally invasive sacrocolpopexy for uterovaginal prolapse.
The objective of this study was to compare TLH versus LSCH at the time of minimally invasive sacrocolpopexy for uterovaginal prolapse, hypothesizing that LSCH would demonstrate a higher proportion of recurrent prolapse, but a lower proportion of mesh exposures.
This was a retrospective, secondary analysis comparing a prospective cohort of patients undergoing TLH sacrocolpopexy versus a retrospective cohort of patients who had undergone LSCH sacrocolpopexy. Our primary outcome was composite anatomic pelvic organ prolapse recurrence (prolapse beyond hymen, apical descent > half vaginal length, retreatment). Secondary outcomes included vaginal mesh exposures.
There were 733 procedures: 184 (25.1%) TLH sacrocolpopexy and 549 (74.9%) LSCH sacrocolpopexy. Median follow-up was longer in the TLH cohort (369 [IQR 354-386] vs 190 [IQR 63-362] days, P < 0.01). There was no difference in composite prolapse recurrence between groups on bivariable analysis (3.3% vs 4.7%, P = 0.40). However, multivariable logistic regression demonstrated that TLH sacrocolpopexy had lower odds of composite pelvic organ prolapse recurrence than LSCH sacrocolpopexy (OR 0.21, 95% CI 0.05-0.82, P = 0.02). Among procedures with lightweight mesh types, TLH demonstrated a higher proportion of mesh exposures compared to LSCH (10 [5.4%] vs 4 [1.1%], P < 0.01); however, this was not significant after controlling for confounders (OR 4.51, 95% CI 0.88-39.25, P = 0.08). There were no differences in retreatment or reoperation.
For the treatment of uterovaginal prolapse, both TLH and LSCH are acceptable methods of concomitant hysterectomy at the time of minimally invasive sacrocolpopexy, albeit with likely different risk profiles.
在微创骶骨阴道固定术治疗子宫阴道脱垂时，比较全腹腔镜子宫切除术（TLH）与腹腔镜次全子宫切除术（LSCH）的数据有限。
本研究的目的是在微创骶骨阴道固定术治疗子宫阴道脱垂时比较TLH与LSCH，假设LSCH将显示更高比例的复发脱垂，但网片暴露比例更低。
这是一项回顾性二次分析，比较接受TLH骶骨阴道固定术的前瞻性队列患者与接受LSCH骶骨阴道固定术的回顾性队列患者。我们的主要结局是复合性解剖学盆腔器官脱垂复发（脱垂超过处女膜、顶端下降超过阴道长度的一半、再次治疗）。次要结局包括阴道网片暴露。
共进行了733例手术：184例（25.1%）TLH骶骨阴道固定术和549例（74.9%）LSCH骶骨阴道固定术。TLH队列的中位随访时间更长（369天[四分位间距354 - 386天]对190天[四分位间距63 - 362天]，P < 0.01）。双变量分析显示两组间复合脱垂复发无差异（3.3%对4.7%，P = 0.40）。然而，多变量逻辑回归表明，TLH骶骨阴道固定术比LSCH骶骨阴道固定术发生复合盆腔器官脱垂复发的几率更低（比值比0.21，95%置信区间0.05 - 0.82，P = 0.02）。在使用轻质网片类型的手术中，与LSCH相比，TLH显示出更高比例的网片暴露（10例[5.4%]对4例[1.1%]，P < 0.01）；然而，在控制混杂因素后，这并不显著（比值比4.51，95%置信区间0.88 - 39.25，P = 0.08）。再次治疗或再次手术方面无差异。
对于子宫阴道脱垂的治疗，在微创骶骨阴道固定术时，TLH和LSCH都是可接受的同期子宫切除术方法，尽管风险特征可能不同。
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