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Title: [Long-term effectiveness of transvaginal high uterosacral ligament suspension].
Author: Duan L, Lu YX, Shen WJ, Liu X, Liu JX, Zhang YH, Ge J, Zhao Y, Niu K, Wang WY.
Journal: Zhonghua Fu Chan Ke Za Zhi; 2017 Jun 25; 52(6):363-368. PubMed ID: 28647957.
Abstract:
Objective: To assess the long-term effectiveness of the transvaginal high uterosacral ligament suspension (HUS) in women suffering from advanced pelvic organ prolapse (POP). Methods: A retrospective review of records identified 118 women who underwent transvaginal HUS with or without additional concomitant anterior and (or) posterior repairs from June 2003 to August 2009 in the First Affiliated Hospital, General Hospital of People's Liberation Army. Of 118 women, 104 women completed the follow-up during study period; these 104 women were analysed. Follow-up visits were performed 2, 6 and 12 months after surgery and then annually. Anatomic results of POP was established by pelvic examination using pelvic organ prolapse quantitation system (POP-Q) staging. Funtional results were obtained by patient global impression of improvement (PGI-I), pelvic floor distress inventory-short form 20 (PFDI-20) and pelvic floor impact questionnaire short form (PFIQ-7). Surgical success required the fulfillment of all 3 criteria: (1) prolapse leading edge of 0 cm or less and apex of 1/2 total vaginal length or less; (2) the absence of pelvic organ prolapse symptoms as reported on the PFDI-20 question No. 3 ( "Do you usually have a bulge or something falling out that you can see or feel in your vaginal area?" ); and (3) no prolapse reoperations or pessary use during the study period. Results: The mean follow-up time was (9.1±1.5) years. The overall surgery success rate was 91.3% (95/104) according to above all 3 criteria. Prolapse recurrence rates were isolated anterior 6.7% (7/104), isolated apical 0, isolated posterior 2.9% (3/104) and multiple compartments 1.0% (1/104). Five women (4.8%, 5/104) developed bothersome vaginal bulge symptoms. None of recurrent women underwent retreatment, including either surgery or use of a pessary at last follow-up. The subjective satisfaction rate was 90.4% (94/104). PFDI-20 and PFIQ-7 scores showed a statistically significant improvement from preoperative 72 and 65 points to postoperative 17 and 9 points respectively (all P<0.01). There was a 2.9% (3/104) rate of intraoperative ureteral kinking and 3.8% (4/104) rate of postoperative morbidity. Conclusions: The transvaginal HUS for vault prolapse offers good long-term anatomical results with excellent vault suspension. With additional concomitant anterior and (or) posterior repairs, it will be a reconstructive surgery for the majority of advanced POP. It is minimal traumatic and appropriate for different type of POP, especially for the eldly patients. It is worthy of being popularized for clinical application. 目的： 研究经阴道宫骶韧带高位悬吊术（HUS）治疗重度盆腔器官脱垂（POP）的远期疗效。 方法： 2003年6月至2009年8月，解放军总医院第一附属医院采用经阴道HUS治疗重度POP共118例，对其中104例完成系统随访患者的临床资料进行回顾性分析。术后2、6、12个月及之后每年1次进行随访，客观疗效评价采用POP定量分度法（POP-Q）分度，主观疗效评价采用患者整体印象改善评分量表（PGI-I）、盆底不适调查表简表（PFDI-20）和盆底功能影响问卷简表（PFIQ-7）评分。采用以下3个标准作为手术成功的标准：（1）脱垂最远端距离处女膜≤0 cm，同时顶端距离处女膜≤1/2阴道全长；（2）根据PFDI-20第3个问题（"经常看到或感到阴道有肿物脱出吗？"）判定相关的POP症状消失；（3）未因脱垂而行再次手术或子宫托治疗。 结果： 104例患者的平均年龄62.5岁，HUS术后平均随访（9.1±1.5）年。同时达到上述3个标准的手术成功率为91.3%（95/104），单独阴道前壁、顶端、后壁以及多部位脱垂的复发率分别为6.7%（7/104）、0、2.9%（3/104）和1.0%（1/104）；按PFDI-20问卷中的第3个问题，自觉有阴道肿物脱出者5例（4.8%，5/104）；无一例行再次手术或子宫托治疗。总体主观满意率为90.4%（94/104）。PFDI-20、PFIQ-7的中位评分由术前的72、65分分别下降至术后9年的17、9分（P均<0.01）。术中输尿管梗阻率2.9%（3/104），均于术中拆除宫骶韧带缝线后重新缝合得以解决；术后病率为3.8%（4/104）。 结论： 经阴道HUS对于阴道顶端悬吊效果好、疗效持久，辅以阴道前、后壁修补可用于治疗绝大多数的重度POP，创伤小、适应证广，适于老年患者，极具临床推广和应用价值。.

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