Guo Lilu, Li Xiaodi, Li Huihua, Wang Binan, Guo Haichun, Wu Jingni
Department of Obstetrics and Gynecology, Changsha Maternal and Child Health Care Hospital, Changsha, China.
Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha, China.
PLoS One. 2025 Sep 12;20(9):e0332526. doi: 10.1371/journal.pone.0332526. eCollection 2025.
To compare perioperative outcomes and long-term anatomical/functional efficacy of laparoscopic lateral suspension (LLS), laparoscopic sacrocolpopexy (LSC), and transvaginal mesh (TVM) procedures in women with POP-Q stage III-IV apical prolapse.
This retrospective cohort included 98 participants undergoing surgical repair between 1/1/2021 and 30/12/2021: 34 TVM, 35 LSC, and 29 LLS. Concomitant hysterectomy or uterine preservation was performed based on clinical indications. Anatomical outcomes were assessed via Pelvic Organ Prolapse Quantification (POP-Q) measurements, while functional outcomes and quality of life (QoL) were evaluated using Pelvic Floor Distress Inventory Questionnaire (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7) questionnaires preoperatively and at 2-year follow-up. Multivariable regression adjusted for age, BMI, parity, and surgical approach.
LLS demonstrated superior perioperative outcomes, including shorter operative time (3.07 ± 0.15 vs. 4.59 ± 0.13 hours for LSC, p < 0.05), reduced blood loss (64.48 ± 4.62 vs. 116.18 ± 8.10 mL for TVM, p < 0.05), and shorter hospitalization (5.17 ± 0.20 vs. 6.21 ± 0.27 days for TVM, p < 0.05). Groin pain incidence was higher in TVM (21% vs. 0% in LSC/LLS, p < 0.05). All groups achieved significant anatomical restoration (POP-Q points p < 0.001) and QoL improvements (PFDI-20: TVM 97.31 → 8.37, LSC 108.92 → 5.76, LLS 110.89 → 6.64; PFIQ-7: TVM 103.86 → 3.45, LSC 113.24 → 9.28, LLS 122.99 → 8.04; p < 0.001). No intergroup differences persisted after adjusting confounders. Notably, TVM participants with uterine preservation reported significantly better PFIQ-7 scores than hysterectomy subgroups (0.96 ± 0.52 vs. 6.60 ± 3.46, p < 0.05), whereas LSC/LLS showed no such disparity.
LLS, LSC, and TVM effectively restore anatomy and QoL in advanced apical prolapse, with LLS offering optimal perioperative safety. Uterine preservation during TVM enhances postoperative satisfaction, suggesting individualized surgical planning is critical. Long-term complications and durability require further investigation.
比较腹腔镜侧方悬吊术（LLS）、腹腔镜骶棘韧带固定术（LSC）和经阴道网片修补术（TVM）治疗盆腔器官脱垂定量分期（POP-Q）Ⅲ - Ⅳ期顶端脱垂女性的围手术期结局以及长期解剖学/功能疗效。
本回顾性队列研究纳入了2021年1月1日至2021年12月31日期间接受手术修复的98例患者：34例行TVM，35例行LSC，29例行LLS。根据临床指征进行同期子宫切除术或保留子宫。通过盆腔器官脱垂定量（POP-Q）测量评估解剖学结局，术前及术后2年随访时使用盆底困扰量表问卷（PFDI - 20）和盆底影响问卷（PFIQ - 7）评估功能结局和生活质量（QoL）。多变量回归分析对年龄、体重指数、产次和手术方式进行了校正。
LLS显示出更好的围手术期结局，包括手术时间更短（LSC为4.59 ± 0.13小时，LLS为3.07 ± 0.15小时，p < 0.05）、失血更少（TVM为116.18 ± 8.10 mL，LLS为64.48 ± 4.62 mL，p < 0.05）以及住院时间更短（TVM为6.21 ± 0.27天，LLS为5.17 ± 0.20天，p < 0.05）。TVM组腹股沟疼痛发生率更高（21%，LSC/LLS组为0%，p < 0.05）。所有组均实现了显著的解剖学恢复（POP - Q评分p < 0.001）和生活质量改善（PFDI - 20：TVM从97.31降至8.37，LSC从108.92降至5.76，LLS从110.89降至6.64；PFIQ - 7：TVM从103.86降至3.45，LSC从113.24降至9.28，LLS从122.99降至8.04；p < 0.001）。校正混杂因素后，组间差异不再存在。值得注意的是，保留子宫的TVM参与者的PFIQ - 7评分显著优于子宫切除亚组（0.96 ± 0.52 vs. 6.60 ± 3.46，p < 0.05），而LSC/LLS组未显示出这种差异。
LLS、LSC和TVM均可有效恢复晚期顶端脱垂患者的解剖结构和生活质量，LLS在围手术期安全性方面表现最佳。TVM术中保留子宫可提高术后满意度，提示个体化手术规划至关重要。长期并发症和耐久性仍需进一步研究。
