Vaginal versus abdominal reconstructive surgery for the treatment of pelvic support defects: A prospective randomized study with long-term outcome evaluation
Vaginal versus abdominal reconstructive surgery for the treatment of pelvic support defects: A prospective randomized study with long-term outcome evaluation
复制标题
DOI：
10.1016/s0002-9378(96)70084-4
复制
发表时间：
1996-12-01
影响因子：
9.8
通讯作者：
McClellan, E
中科院分区：
文献类型：
--
作者：
Benson, JT;Lucente, V;McClellan, E
研究设计：88例宫颈脱垂至处女膜或超出处女膜或阴道穹隆内翻50%且阴道前壁下降至处女膜或超出处女膜的患者随机分为阴式和腹式两种手术方式。48名妇女接受了经阴道入路双侧骶棘穹隆悬吊术和阴道旁修补术，40名妇女接受了经腹入路悬吊和阴道旁修补术。辅助性手术按要求进行。术后由非外科医生合著者每年进行详细的骨盆检查，最长可达5年。这些女性在最紧张的时候站着接受检查。如果女性仍无症状，阴道顶端支撑在提肌钢板上方，且处女膜外没有任何阴道组织突出，则手术被归类为最佳有效。如果女性有症状，顶端下降50%，或阴道壁突出超过处女膜，则手术效果不令人满意。结果：80名女性(阴道42例，腹部38例)可用于1~5.5岁(平均2.5年)的评估。两组患者在年龄、体重、产次和雌激素水平方面相似，56%的患者曾接受过盆腔手术。两组在发病率、并发症、血红蛋白变化、性交困难、疼痛或住院时间方面没有显著差异。阴道组的导尿管使用时间更长，尿路感染更多，尿失禁更多，手术时间更短，住院费用更低。阴道组和腹腔组的手术效果分别为29%和58%，但效果不佳，导致33%的阴道组和16%的腹腔组再次手术。再次手术包括12%的阴道组和2%的腹部组的复发性尿失禁。经腹入路手术效果最佳的相对危险度为2.03(95%可信区间1.22~9.83)，经阴道入路手术效果不满意的相对危险度为2.11(95%可信区间0.90~4.94)。结论：经腹入路骨盆重建手术矫正严重的骨盆支持缺损效果较好。
OBJECTIVES: Our purpose was to determine whether a vaginal or abdominal approach is more effective in correcting uterovaginal prolapse.STUDY DESIGN: Eighty-eight women with cervical prolapse to or beyond the hymen or with vaginal vault inversion >50% of its length and anterior vaginal wall descent to or beyond the hymen were randomized to a vaginal versus abdominal surgical approach. Forty-eight women underwent a vaginal approach with bilateral sacrospinous vault suspension and paravaginal repair, and 40 women underwent an abdominal approach with colposacral suspension and paravaginal repair. Ancillary procedures were performed as indicated. Detailed pelvic examination was performed postoperatively by the nonsurgeon coauthor yearly up to 5 years. The women were examined while standing during maximum strain. Surgery was classified as optimally effective if the woman remained asymptomatic, the vaginal apex was supported above the levator plate, and no protrusion of any vaginal tissue beyond the hymen occurred. Surgical effectiveness was considered unsatisfactory if the woman was symptomatic, the apex descended >50% of its length, or the vaginal wall protruded beyond the hymen.RESULTS: Eighty women (vaginal 42, abdominal 38) were available for evaluation at 1 to 5.5 years (mean 2.5 years). The groups were similar in age, weight, parity, and estrogen status, and 56% had undergone prior pelvic surgery. There was no significant difference between the groups in morbidity, complications, hemoglobin change, dyspareunia, pain, or hospital stay. The vaginal group had longer catheter use, more urinary tract infections, more incontinence, decreased operative time, and lower hospital charge. Surgical effectiveness was optimal in 29% of the vaginal group and 58% of the abdominal group and was unsatisfactory leading to reoperation in 33% of the vaginal group and 16% of the abdominal group. The reoperations included procedures for recurrent incontinence in 12% of the vaginal and 2% of the abdominal groups. The relative risk of optimal effectiveness by the abdominal route is 2.03 (95% confidence interval 1.22 to 9.83), and the relative risk of unsatisfactory outcome using the vaginal route is 2.11 (95% confidence interval 0.90 to 4.94).CONCLUSIONS: Reconstructive pelvic surgery for correction of significant pelvic support defects was more effective with an abdominal approach.