Lou Jicheng, Guo Feng
Department of Gynecology and Obstetrics, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China.
Key Laboratory for Molecular Diagnosis of Hubei Province, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China.
BMC Womens Health. 2025 Mar 18;25(1):124. doi: 10.1186/s12905-025-03643-0.
This study aimed to summarize the evidence available in the published literature on concomitant hysterectomy versus uterine preservation in the treatment of pelvic organ prolapse (POP) and to clarify whether uterine removal should be performed during pelvic floor reconstructive surgery using transvaginal mesh (TVM).
The literature search strategy was specifically designed to identify articles investigating the comparison of concomitant hysterectomy and uterine preservation in pelvic floor reconstruction using TVM. The database search spanned from their inception until March 2024. The literature selection and data collection processes were guided by predetermined inclusion and exclusion criteria. The included studies were independently evaluated by two reviewers, and a meta-analysis was conducted utilizing RevMan 5.4.
Eleven retrospective studies involving 1341 patients were selected for meta-analysis. The results showed no statistically significant differences in the objective cure rate or the risk of recurrence between concomitant hysterectomy and uterine preservation. Compared to uterine preservation, concomitant hysterectomy surgery was associated with extended operative duration (MD 31.59, 95% CI 19.49 - 43.68, p < 0.00001), longer hospital stay (MD 1.29, 95% CI 0.67 - 1.92, p < 0.0001), increased intraoperative blood loss (MD 62.52, 95% CI 30.18 - 94.86, p = 0.0002), reduced PISQ-12 scores (MD -5.99, 95% CI -9.70 to -2.28, p = 0.002), decreased postoperative total vaginal length (MD -0.66, 95% CI -1.14 to -0.18, p = 0.007), and higher risk of mesh exposure (RR 1.95, 95% CI 1.18-3.23, p = 0.009).
Uterine sparing surgery using TVM compared to concomitant hysterectomy surgery using TVM showed equally effective in the treatment of POP at short and medium term follow-up. But uterine preservation could reduce intraoperative blood loss, operative duration, and duration of hospitalization. In addition, uterine sparing surgery is beneficial for decreasing the risk of mesh exposure, increasing the vaginal length and improving sexual satisfaction.
本研究旨在总结已发表文献中关于在盆腔器官脱垂（POP）治疗中同时行子宫切除术与保留子宫的现有证据，并阐明在经阴道网片（TVM）盆底重建手术中是否应进行子宫切除。
文献检索策略专门设计用于识别研究在使用TVM进行盆底重建时同时行子宫切除术与保留子宫的比较的文章。数据库检索从其建立到2024年3月。文献选择和数据收集过程遵循预先确定的纳入和排除标准。纳入的研究由两名评审员独立评估，并使用RevMan 5.4进行荟萃分析。
11项涉及1341例患者的回顾性研究被选入荟萃分析。结果显示，同时行子宫切除术与保留子宫在客观治愈率或复发风险方面无统计学显著差异。与保留子宫相比，同时行子宫切除术的手术时间延长（MD 31.59，95%CI 19.49 - 43.68，p < 0.00001），住院时间更长（MD 1.29，95%CI 0.67 - 1.92，p < 0.0001），术中失血量增加（MD 62.52，95%CI 30.18 - 94.86，p = 0.0002），PISQ - 12评分降低（MD -5.99，95%CI -9.70至 -2.28，p = 0.002），术后总阴道长度缩短（MD -0.66，95%CI -1.14至 -0.18，p = 0.007），网片暴露风险更高（RR 1.95，95%CI 1.18 - 3.23，p = 0.009）。
与使用TVM同时行子宫切除术相比，使用TVM保留子宫的手术在短期和中期随访中治疗POP同样有效。但保留子宫可减少术中失血量、手术时间和住院时间。此外，保留子宫的手术有利于降低网片暴露风险、增加阴道长度并提高性满意度。
