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  • Title: [Mid-term efficacy of laparoscopic sacral colpopexy of combined transabdominal-transvaginal approach in the treatment of stage Ⅳ pelvic organ prolapse].
    Author: Liang XZ, Xu LZ, Chen LQ, Wang S, Lin XT, Zhang XW.
    Journal: Zhonghua Fu Chan Ke Za Zhi; 2019 Mar 25; 54(3):160-165. PubMed ID: 30893716.
    Abstract:
    Objective: To evaluate the clinical effect after laparoscopic sacral colpopexy (LSC) of combined transabdominal-transvaginal approach on stage Ⅳ pelvic organs prolapse (POP). Methods: The clinical data of 65 patients undergoing LSC of combined transabdominal-transvaginal approach from January 1st, 2010 to July 30th, 2017 due to POP stage Ⅳ in First Affiliated Hospital of Guangzhou Medical University were retrospectively analyzed. Objective outcome was assessed by comparing preoperative and postoperative pelvic organ prolapse quantification (POP-Q) systems. Subjective effects were assessed by comparing pelvic floor distress inventory-short form 20 (PFDI-20), pelvic floor impact questionnaire short form (PFIQ-7), pelvic organ prolapse/urinary incontinence sexual questionnaire-12 (PISQ-12) and patient global impression of improvement (PGI-I). Results: All 65 patients were successfully performed without any intraoperative complications. Fifty-three patients were followed in the clinic department and 12 were followed up by telephone. The follow-up duration was 6.1-80.3 months and the median follow-up duration was 24.5 months. The bleeding loss was 20-250 ml. Postoperative urethral catheter residence day was (2.5±1.1) days, length of postoperative stay was (6.2±1.7) days. The postoperative POP-Q scores were compared with preoperative scores which had significantly improved except pb (all P<0.01). The objective cure rates of vaginal anterior wall, apical and posterior wall prolapse stage Ⅳ were 90% (47/52), 100% (23/23) and 95% (20/21).About PGI-I, except for 1 patient who chose "improvement" , the other 64 patients (98%, 64/65) all chose "significant improvement" . Furthermore, preoperative and postoperative PFDI-20, PFIQ-7, and PISQ-12 scores were all statistically significant (all P<0.01). Subjective efficacy was significant. Three cases (5%, 3/65) of postoperative fever occurred. Two cases (4%, 2/53) had mesh exposure. Six patients (11%, 6/53) had recurrence of postoperative prolapse. Five cases had recurrence of vaginal anterior wall prolapse and no reoperation was performed; 1 case was recurrence of posterior vaginal wall prolapse who diagnosed as vaginal posterior wall prolapse stage Ⅲ; no recurrence of apical prolapse. The rate of reoperation (including exposed-mesh removal and pelvic floor reconstruction surgery) was 5% (3/65). Conclusions: The LSC of combined transabdominal-transvaginal approach has a high subjective efficacy rate. The objective cure rate in the case of apical prolapse stage Ⅳ is one hundred percent.The LSC of combined transabdominal-transvaginal approach has low mesh exposure, low postoperative infection and the reoperation rate, which is one of optional pelvic floor reconstruction surgery. However, there is still a risk of recurrence in patients with POP stage Ⅳ with severe bladder bulging. 目的： 探讨"阴腹联合"腹腔镜阴道骶骨固定术治疗Ⅳ度盆腔器官脱垂的中期疗效。 方法： 回顾性分析2010年1月1日至2017年7月30日因Ⅳ度盆腔器官脱垂在广州医科大学附属第一医院行"阴腹联合"腹腔镜阴道骶骨固定术患者65例的临床资料。通过比较术前、术后盆腔器官脱垂定量（POP-Q）分度法的各指示点位置评估客观疗效，以盆底不适调查表简表（PFDI-20）、盆底功能影响问卷简表（PFIQ-7）、盆底器官脱垂与尿失禁性功能问卷（PISQ-12）、患者整体印象改善评分（PGI-I）评估主观疗效。采用门诊和电话的方式随访。 结果： 65例患者均顺利完成手术，无术中并发症，术中出血量20~250 ml，术后留置尿管天数为（2.5±1.1）d，术后住院天数为（6.2±1.7）d。门诊随访53例，电话随访12例，随访时间为6.1~80.3个月，中位随访时间为24.5个月。术前、术后POP-Q指示点（Aa、Ba、C、TVL、Ap、Bp、gh）的位置分别比较，差异均有统计学意义（P均<0.01）。阴道前壁、阴道顶端及阴道后壁脱垂Ⅳ度的客观治愈率分别为90%（47/52）、100%（23/23）和95%（20/21）。PGI-I评分除1例患者为"有改善"外，其余64例（98%，64/65）均为"明显改善"；65例患者术前、术后的PFDI-20、PFIQ-7、PISQ-12评分分别比较，差异均有统计学意义（P均<0.01），主观疗效显著。术后并发症：术后病率5%（3/65）；网片暴露2例（4%，2/53），其中1例为阴道顶端网片暴露、1例为阴道前壁网片暴露。术后复发：6例患者（11%，6/53）术后脱垂复发，其中5例为阴道前壁脱垂复发，均为POP-QⅡ度，无脱垂相关症状，均未再次手术；1例为阴道后壁脱垂复发，诊断为阴道后壁脱垂Ⅲ度。无阴道顶端脱垂复发。再次手术率（包括暴露网片清除术2例及后盆腔重建术1例）为5%（3/65）。 结论： "阴腹联合"腹腔镜阴道骶骨固定术对于Ⅳ度盆腔器官脱垂患者的主观治愈率高，阴道顶端脱垂的客观治愈率也高，网片暴露率低，再次手术率低，术后感染率低，是可选择的盆底重建术式之一；但对于阴道前壁脱垂Ⅳ度伴重度膀胱膨出的患者仍存在一定的复发风险。.
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