Colombo M, Milani R
Department of Obstetrics and Gynecology, San Gerardo Hospital, Third Branch of the University of Milan, Monza, Italy.
Am J Obstet Gynecol. 1998 Jul;179(1):13-20. doi: 10.1016/s0002-9378(98)70245-5.
Our purpose was to compare anatomic and functional results of 2 procedures performed at vaginal hysterectomy for vaginal vault suspension in patients with advanced uterovaginal prolapse.
A retrospective case-control study was designed comparing 62 patients who underwent sacrospinous ligament fixation and 62 members of a matched control group who underwent modified McCall culdoplasty during vaginal hysterectomy and reconstructive pelvic surgery. The 62 pairs were matched for grade of uterine prolapse, age, parity, dystocia, menopause, body mass index, previous prolapse surgery, heavy work, constipation, and chronic cough.
Operative time and blood loss were significantly greater (P < .001) in the group with sacrospinous suspension. With a follow-up from 4 to 9 years, 17 (27%) patients receiving sacrospinous suspension had prolapse recurrence at any vaginal site compared with 9 (15%) patients receiving modified McCall culdoplasty (P = .14). Recurrent vault prolapse was recorded in 5 (8%) and 3 (5%) subjects, respectively (P = .72). Thirteen (21%) and 4 (6%) patients, respectively, had recurrent cystocele (matched odds ratio 4.1, 95% confidence interval 1.3 to 14.2, P = .04). No significative difference was observed in postoperative sexual function.
Sacrospinous ligament fixation is not recommended as a prophylactic measure at vaginal hysterectomy in patients with uterovaginal prolapse.
我们的目的是比较在晚期子宫阴道脱垂患者行阴道子宫切除术时进行的两种阴道穹窿悬吊手术的解剖学和功能结果。
设计一项回顾性病例对照研究，比较62例行骶棘韧带固定术的患者和62例在阴道子宫切除术及盆底重建手术中接受改良麦考尔直肠子宫固定术的匹配对照组患者。这62对患者在子宫脱垂程度、年龄、产次、难产史、绝经状态、体重指数、既往脱垂手术史、重体力劳动、便秘和慢性咳嗽方面进行了匹配。
骶棘韧带悬吊组的手术时间和失血量显著更多（P < .001）。随访4至9年，17例（27%）接受骶棘韧带悬吊术的患者在任何阴道部位出现脱垂复发，而接受改良麦考尔直肠子宫固定术的患者有9例（15%）（P = .14）。分别有5例（8%）和3例（5%）患者出现穹窿脱垂复发（P = .72）。分别有13例（21%）和4例（6%）患者出现膀胱膨出复发（匹配优势比4.1，95%置信区间1.3至14.2，P = .04）。术后性功能方面未观察到显著差异。
对于子宫阴道脱垂患者，不建议在阴道子宫切除术时将骶棘韧带固定术作为预防措施。
