Management of Apical Compartment Prolapse (Uterine and Vault Prolapse): A FIGO Working Group Report
Management of Apical Compartment Prolapse (Uterine and Vault Prolapse): A FIGO Working Group Report
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DOI：
10.1002/nau.22916
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发表时间：
2017-02-01
影响因子：
2
通讯作者：
Zanni, Giuliano
中科院分区：
文献类型：
--
作者：
Betschart, Cornelia;Cervigni, Mauro;Zanni, Giuliano
目的：心尖脱垂包括子宫下降、阴道断端下降或仅宫颈下降。据估计，女性有11-19%的终身风险接受手术治疗POP。预计这一比例将在未来20 - 30年增加。在这份FIGO工作组报告中，我们讨论了根尖脱垂的保守和手术治疗方案。研究方法：FIGO工作组“盆底医学和重建手术”根据文献证据、成本效益、难易程度描述了根尖脱垂的不同治疗方法，并总结了专家建议。结果如下：在保守治疗方案中，子宫托是几个世纪以来最成功的选择，并发症发生率低，成本低。在阴道手术中，骶棘韧带固定术（SSLF）和子宫骶韧带悬吊术（USLS）的结局和有效性相当，但并发症模式不同，相当低，成本效益良好。骶骨阴道固定术，独立于开腹、腹腔镜或机器人辅助腹腔镜技术，具有良好的耐久性和生活质量表现。微创技术与开腹技术同样有效，补片暴露无差异。结论：阴道手术是描述良好的手术，具有良好的结局和成本效益。骶骨阴道固定术有很高的有效性;关于其性能和长期结局的数据尚待确定。与自体组织手术或任何保守治疗相比，补片植入物的成本更高，建议进行进一步研究以评价数十年内的治愈率和可能的长期补片并发症。(C)2015 Wiley Periodicals，Inc.
Aim: Apical prolapse includes descent of the uterus, vagina cuff, or rarely solely of the cervix. It is estimated that women have an 11-19% life-time risk of undergoing surgery for POP. This rate is projected to increase over the next 2-3 decades. In this FIGO working group report we address the conservative and surgical treatment options for apical prolapse. Methods: The FIGO working group "Pelvic Floor Medicine and Reconstructive Surgery" describes the different treatments for apical prolapse based on the literature evidence, the cost-effectiveness, the degree of difficulty and summed them up with an experts recommendation. Results: Among the conservative treatment options, pessaries are the most successful options since centuries with a low complication rate and low costs. Among the vaginal operative procedures the sacrospinous ligament fixation (SSLF) and the uterosacral ligament suspension (USLS) show comparable outcomes and efficacy with a different, however, rather low complication pattern and a favorable cost-benefit profile. Sacrocolpopexy, independent on the open abdominal, laparoscopic, or robotic-assisted laparoscopic technique has a good durability and quality of life performance. The minimal invasive techniques are as effective as the open abdominal techniques and there is no difference in mesh exposure. Conclusion: Vaginal procedures are well described procedures with favorable outcomes and cost-benefit profiles. Sacral colpopexy has a high-effectivity; data on the route of performance and long-term outcome are awaited. The cost with mesh implants are higher compared to the operations with autologous tissue or any conservative treatment and further studies are recommended to evaluate the cure rates in the span of decades and the possible long-term mesh complications. (C) 2015 Wiley Periodicals, Inc.