Iliococcygeus or sacrospinous fixation for vaginal vault prolapse
Iliococcygeus or sacrospinous fixation for vaginal vault prolapse
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DOI：
10.1016/s0029-7844(01)01378-3
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发表时间：
2001-07-01
影响因子：
7.2
通讯作者：
Ugoni, AM
中科院分区：
文献类型：
--
作者：
Maher, CF;Murray, CJ;Ugoni, AM
目的：比较骶尾肌固定术和髂尾肌固定术治疗有症状性阴道穹隆脱垂的疗效。方法：1994~1998年间，78例患者行骶尾肌固定术，50例行髂尾肌固定术。设计了一项配对的病例对照研究来比较这两种方法。匹配的变量包括年龄、产次、体重指数、穹隆脱垂程度、绝经、性活动、便秘、既往脱垂或大小便失禁手术、压力性大小便失禁和复查时间。结果：髂尾骨组的主观成功率为91%，而骶棘组的主观成功率为94%(P=.73)。客观成功率分别为53%和67%(P=0.36)，患者对手术的满意度分别为100分中的78分和100分中的91分(P=0.01)。术后平均随访时间：髂尾组为21个月，骶棘组为19个月(P=.52)。髂尾组恢复时间为54天，而骶棘组为39天(P=0.04)。两组术后膀胱膨出和阴部神经血管束损伤的发生率无明显差异。结论：两种固定方法治疗阴道穹隆脱垂的疗效相当，术后膀胱膨出、臀部疼痛和需输血的发生率相似。在阴道穹隆脱垂的治疗中，不应摒弃骶棘韧带固定术而采用髂尾肌固定术。(C)2001年，由美国妇产科医师学会提供。
Objective: To compare iliococcygeus (prespinous) and sacrospinous fixation for vaginal vault prolapse.Methods: Between 1994 and 1998, 78 women underwent sacrospinous colpopexy and 50 underwent iliococcygeus fixation for the management of symptomatic vaginal vault prolapse. A matched case-control study was designed to compare the two approaches. The matched variables included age, parity, body mass index, degree of vault prolapse, menopause, sexual activity, constipation, previous prolapse or continence surgery, stress incontinence, and length of review. Thirty-six matched pairs were isolated, resulting in a study with a power of 50% to detect a 20% difference in the success rates between the two groups.Results: The subjective success rate for the iliococcygus group was 91%; it was 94% for the sacrospinous group (P = .73). The objective success rate was 53% and 67% (P = .36), and the patient satisfaction with surgery was 78 of 100 and 91 of 100 (P = .01) on a visual analogue scale. The mean length of postoperative follow-up was 21 months for the iliococcygeus group and 19 months for the sacrospinous group (P = .52). The recovery time was 54 days in the iliococcygeus group and 39 days in the sacrospinous group (P = .04). No significant difference was seen in the incidence of postoperative cystoceles or damage to the pudendal neurovascular bundle.Conclusion: Sacrospinous and iliococcygeus fixation are equally effective procedures for vaginal vault prolapse and have similar rates of postoperative cystocele, buttock pain, and hemorrhage requiring transfusion. The sacrospinous ligament fixation should not be discarded in favor of the iliococcygeus fixation in the management of vaginal vault prolapse. (C) 2001 by the American College of Obstetricians and Gynecologists.