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Title: [A five-year analysis of effect on transvaginal high uterosacral ligament suspension with or without native-tissue repair for middle compartment defect].
Author: Zhang YH, Lu YX, Liu X, Liu JX, Shen WJ, Zhao Y, Niu K, Wang WY.
Journal: Zhonghua Fu Chan Ke Za Zhi; 2019 Jul 25; 54(7):445-451. PubMed ID: 31365956.
Abstract:
Objective: To assess the five-year effect of the transvaginal high uterosacral ligament suspension (HUS) with or without additional concomitant native-tissue anterior and (or) posterior repair in women suffering from middle compartment defect. Methods: A retrospective review of records identified 79 women who underwent transvaginal HUS with or without additional concomitant native-tissue anterior and (or) posterior repair from January 2007 to January 2018 in Fourth Medical Center, General Hospital of People's Liberation Army. The middle compartment defects were predominant in these patients with point C no less than point Ba or Bp if accompanied with anterior or posterior vaginal wall prolapse. Follow-up visits were performed 2,6 and 12 months after surgery and then annually. Anatomic results of pelvic organ prolapse (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) scale in POP, 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) anterior or posterior vaginal wall prolapsed leading edge of 0 cm or less and apex of 1/2 total vaginal length or less; (2) the absence of POP 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: Of 79 women, 51(65%, 51/79) women completed the five-year follow-up during the study period. The median follow-up time was 5.2 years (2.8-8.3 years). The overall surgery success rate was 86% (44/51) according to above all 3 criteria. Prolapse recurrence rates were isolated anterior 8% (4/51), isolated apical 0, isolated posterior 2% (1/51) and multiple compartments 4% (2/51). Seven women (14%,7/51) developed anterior or posterior prolapse beyond the hymen with the leading edge≤1 cm. No apical prolapsed occurred. None of recurrent women underwent retreatment,including either surgery or pessary usage at last follow-up. The subjective satisfaction rate was 90% (46/51). There was a 1% (1/79) rate of intraoperative ureteral kinking and 3% (2/79) rate of postoperative morbidity. Conclusions: The transvaginal HUS for middle compartment defect offers good long-term anatomical results with excellent vault suspension. With additional concomitant native-tissue anterior and (or) posterior repair, it will be a reconstructive surgery for the majority of moderate-to-severe POP. It is minimal traumatic and worthy of being popularized for clinical application. 目的： 研究经阴道宫骶韧带高位悬吊（HUS）为主体术式的自体组织修补手术治疗中盆腔缺陷的5年疗效。 方法： 2007年1月至2018年1月期间，对在解放军总医院第四医学中心采用经阴道HUS为主体术式的自体组织修补手术治疗中盆腔缺陷患者79例的临床资料进行回顾性分析。采用盆腔器官脱垂定量（POP-Q）分度法，79例均为中盆腔缺陷为主且≥Ⅱ度。合并有阴道前、后壁脱垂者，其POP-Q指示点C点均≥Ba点或Bp点。均因脱垂初次手术。术后2、6、12个月及之后每年1次随访，客观疗效评价采用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条作为手术成功的标准：（1）阴道前后壁脱垂最远端距离处女膜≤0 cm，同时顶端下降距离≤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？"）判定相关的盆腔器官脱垂症状消失；（3）未因脱垂而再行手术或子宫托治疗。 结果： 术后随访时间≥5年者51例（65%，51/79），术后随访时间的中位数为5.2年（2.8~8.3年）。符合3条标准的总体手术成功率为86%（44/51）。单独阴道前壁、顶端、后壁及多部位脱垂的5年复发率分别为8%（4/51）、0、2%（1/51）、4%（2/51）。术后5年时，阴道前后壁最远端超出处女膜者有7例（14%，7/51），其最远端距离处女膜≤1 cm。无顶端脱垂。无再次要求手术或子宫托治疗者。手术总体主观满意率达90%（46/51）。术中输尿管梗阻1例（1%，1/79），于术中拆除宫骶韧带缝线重新缝合后解决。术后病率为3%（2/79）。 结论： 经阴道HUS手术治疗中盆腔缺陷疗效持久且经济微创，辅以自体组织阴道前后壁修补术可治疗绝大多数中重度中盆腔缺陷患者，值得临床推广应用。.

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