Oi Yuka, Matsunaga Tatuya, Nakagawa Sayako, Dofutsu Mihoko, Segawa Keiko, Shimura Mai, Arata Yoshiko, Furuno Atsuko, Katayama Kayo, Chaki Osamu
Obstetrics and Gynecology, Yokohama Rosai Hospital, Yokohama, JPN.
Obstetrics and Gynecology, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, JPN.
Cureus. 2025 Aug 8;17(8):e89647. doi: 10.7759/cureus.89647. eCollection 2025 Aug.
Introduction Pelvic organ prolapse (POP) affects up to 30% of women during their lifetime and significantly impairs quality of life. In Japan, laparoscopic sacrocolpopexy was covered by national insurance starting in 2014 and has become an established treatment option. Objective This study evaluates the long-term outcomes of POP surgery, including recurrence and complications, seven years after the introduction of sacrocolpopexy at our institution. Methods Our institution introduced sacrocolpopexy in 2016, while continuing to perform conventional vaginal surgery. Sacrocolpopexy was primarily offered to patients under 80 years of age without diabetes; for other patients, vaginal surgery was generally chosen. Among vaginal surgeries, patients with a favorable general condition underwent native tissue repair (NTR). We retrospectively reviewed the medical records of patients who underwent sacrocolpopexy or NTR between April 2016 and June 2023. Results During the period, 90 patients underwent POP surgery, with 37 undergoing sacrocolpopexy and 38 receiving NTR; these 75 cases were included in the analysis. In the sacrocolpopexy group, the median time from symptom onset to surgery was 24 months, and 22 patients had used a pessary preoperatively. The median operative time for sacrocolpopexy was 196 minutes, with minimal bleeding and no intraoperative complications. Postoperative adverse events after sacrocolpopexy included one case each of delirium and acute cholecystitis. Recurrence of stage II or higher POP was observed in three patients in the sacrocolpopexy group; two of these had preoperative stage IV disease and had waited 60 months from symptom onset to surgery. In the NTR group, the median time to surgery was 42 months, and 32 patients had used a pessary preoperatively. The median operative time for NTR was 89 minutes, with minimal bleeding and no intraoperative complications. One postoperative complication (vaginal cuff hematoma) was observed after NTR. Recurrence of POP stage II or higher occurred in three NTR patients, all of whom were stage III or higher preoperatively. Conclusion Sacrocolpopexy and NTR are effective surgical options for POP, particularly in patients who do not respond to conservative management. Although sacrocolpopexy and NTR had a low complication and recurrence rate, it is important to bear in mind that recurrence is possible.
引言
盆腔器官脱垂（POP）在女性一生中的影响率高达30%，并严重损害生活质量。在日本，腹腔镜骶骨阴道固定术自2014年起纳入国家医保，已成为一种既定的治疗选择。
目的
本研究评估了在我院引入骶骨阴道固定术后七年，POP手术的长期效果，包括复发和并发症情况。
方法
我院于2016年引入骶骨阴道固定术，同时继续开展传统阴道手术。骶骨阴道固定术主要提供给80岁以下无糖尿病的患者；其他患者一般选择阴道手术。在阴道手术中，一般状况良好的患者接受自体组织修复（NTR）。我们回顾性分析了2016年4月至2023年6月期间接受骶骨阴道固定术或NTR的患者的病历。
结果
在此期间，90例患者接受了POP手术，其中37例行骶骨阴道固定术，38例接受NTR；这75例纳入分析。在骶骨阴道固定术组，从症状出现到手术的中位时间为24个月，22例患者术前使用过子宫托。骶骨阴道固定术的中位手术时间为196分钟，出血极少，无术中并发症。骶骨阴道固定术后的术后不良事件包括1例谵妄和1例急性胆囊炎。骶骨阴道固定术组有3例患者出现II期或更高分期的POP复发；其中2例术前为IV期疾病，从症状出现到手术等待了60个月。在NTR组，手术的中位时间为42个月，32例患者术前使用过子宫托。NTR的中位手术时间为89分钟，出血极少，无术中并发症。NTR术后观察到1例并发症（阴道残端血肿）。3例NTR患者出现II期或更高分期的POP复发，术前均为III期或更高分期。
结论
骶骨阴道固定术和NTR是治疗POP的有效手术选择，尤其适用于对保守治疗无反应的患者。虽然骶骨阴道固定术和NTR的并发症和复发率较低，但必须牢记复发是有可能的。
