Ligament shortening compared to vaginal colpopexy at the time of hysterectomy for pelvic organ prolapse
Ligament shortening compared to vaginal colpopexy at the time of hysterectomy for pelvic organ prolapse
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DOI：
10.1007/s00192-016-3201-7
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发表时间：
2017-06-01
影响因子：
1.8
通讯作者：
Morgan, Daniel M.
中科院分区：
文献类型：
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作者：
Fairchild, Pamela S.;Kamdar, Neil S.;Morgan, Daniel M.
盆腔器官脱垂子宫切除术时阴道固定术的表现是手术质量的潜在指标。然而，阴道阴道固定术尚未与经典的韧带缩短和复位技术进行直接比较。我们试图检验这些技术之间脱垂复发没有差异的零假设。我们对 330 例因脱垂而进行的阴道子宫切除术进行了回顾性图表审查，比较了阴道阴道固定术（子宫骶韧带悬吊或骶棘韧带悬吊）患者与韧带缩短和复位患者之间的症状和/或解剖复发率。在单变量分析中，使用与复发显着相关的临床相关变量来创建多变量逻辑回归模型来预测复发。平均随访 20 个月，症状和/或解剖复发率之间没有显着差异：19.4% 的患者（211 人中的 41 人）患有阴道固定术，而 11.8% 的患者（119 人中的 14 人）患有韧带缩短 (p = 0.07)。阴道固定术患者的基线脱垂阶段（中位数 3，IQR 2 - 5）高于韧带缩短患者（中位数 2，IQR 1 - 3；p ae 0.0001）。在多变量逻辑回归分析中，所执行的手术与复发无关（OR 1.57，95 % CI 0.79 - 3.12）。基线脱垂 4 cm 或以上与复发相关（OR 2.63，95 % CI 1.32 - 5.22），子宫切除术后的时间也与复发相关（OR 1.02 每月，95 % CI 1.01 - 1.04）。与阴道阴道固定术相比，在阴道子宫切除术时选择性使用韧带缩短技术与相似的复发率相关。脱垂复发。术前脱垂大小是与复发最密切相关的因素。
The performance of a colpopexy at the time of hysterectomy for pelvic organ prolapse is a potential indicator of surgical quality. However, vaginal colpopexy has not been directly compared with the classic technique of ligament shortening and reattachment. We sought to test the null hypothesis that there is no difference in prolapse recurrence between the techniques.We performed a retrospective chart review of 330 vaginal hysterectomies performed for prolapse, comparing symptomatic and/or anatomic recurrence rates between patients having a vaginal colpopexy (uterosacral ligament suspension or sacrospinous ligament suspension) and those having ligament shortening and reattachment. Clinically relevant variables significantly associated with recurrence in a univariate analysis were used to create a multivariable logistic regression model to predict recurrence.With a mean follow-up of 20 months, there was no significant difference between symptomatic and/or anatomic recurrence rates: 19.4 % of patients (41 of 211) having colpopexy vs. 11.8 % of patients (14 of 119) having ligament shortening (p = 0.07). Baseline prolapse stage was higher in patients having colpopexy (median 3, IQR 2 - 5) than in those having ligament shortening (median 2, IQR 1 - 3; p ae 0.0001). In the multivariable logistic regression analysis, the procedure performed was not associated with recurrence (OR 1.57, 95 % CI 0.79 - 3.12). A baseline prolapse of 4 cm or greater was associated with recurrence (OR 2.63, 95 % CI 1.32 - 5.22), as was the time since hysterectomy (OR 1.02 per month, 95 % CI 1.01 - 1.04).When compared with vaginal colpopexy, selective use of the ligament shortening technique at the time of vaginal hysterectomy was associated with similar rates of prolapse recurrence. Preoperative prolapse size was the factor most strongly associated with recurrence.