PDF(Pubmed)
Abstract：
Laparoscopic sacrocolpopexy (LSC) and robot-assisted sacrocolpopexy (RSC) using mesh are popular approaches for treating pelvic organ prolapse (POP). However, it is not uncommon that native tissue repair (NTR) should be presented as an option to patients who are expected to have extensive intraperitoneal adhesion or patients for whom LSC or RSC is difficult owing to various risk factors. Laparoscopic vaginal stump-uterosacral ligament fixation (Shull method) has been introduced as a method for NTR in case of POP. However, effective repair using this surgical procedure may not be possible in severe POPs. To solve the problems of the Shull method, we devised the laparoscopic vaginal stump-round ligament fixation (Kakinuma method) in which the vaginal stump is fixed to the uterine round ligament, a histologically strong tissue positioned anatomically higher than the uterosacral ligament. This study aimed to retrospectively and clinically compare the two methods.
Of the 78 patients who underwent surgery for POP between January 2017 and June 2022 and postoperative follow-up for at least a year, 40 patients who underwent the Shull method (Shull group) and 38 who underwent the Kakinuma method (Kakinuma group) were retrospectively analyzed.
No significant differences were observed between the two groups in patient background variables such as mean age, parity, body mass index, and POP-Q stage. The mean operative duration and mean blood loss in the Shull group were 140.5 ± 31.7 min and 91.3 ± 96.3 ml, respectively, whereas the respective values in the Kakinuma group were 112.2 ± 25.3 min and 31.4 ± 47.7 ml, respectively. Thus, compared with the Shull group, the operative duration was significantly shorter (P < 0.001) and blood loss was significantly less (P = 0.003) in the Kakinuma group. Recurrence was observed in six patients (15.0%) in the Shull group and two patients (5.3%) in the Kakinuma group. Hence, compared with the Shull group, recurrence was significantly less in the Kakinuma group (P = 0.015). No patients experienced perioperative complications in either group.
The results suggest that the Kakinuma method can serve as a novel and viable NTR procedure for POP.
Of the 78 patients who underwent surgery for POP between January 2017 and June 2022 and postoperative follow-up for at least a year, 40 patients who underwent the Shull method (Shull group) and 38 who underwent the Kakinuma method (Kakinuma group) were retrospectively analyzed.
No significant differences were observed between the two groups in patient background variables such as mean age, parity, body mass index, and POP-Q stage. The mean operative duration and mean blood loss in the Shull group were 140.5 ± 31.7 min and 91.3 ± 96.3 ml, respectively, whereas the respective values in the Kakinuma group were 112.2 ± 25.3 min and 31.4 ± 47.7 ml, respectively. Thus, compared with the Shull group, the operative duration was significantly shorter (P < 0.001) and blood loss was significantly less (P = 0.003) in the Kakinuma group. Recurrence was observed in six patients (15.0%) in the Shull group and two patients (5.3%) in the Kakinuma group. Hence, compared with the Shull group, recurrence was significantly less in the Kakinuma group (P = 0.015). No patients experienced perioperative complications in either group.
The results suggest that the Kakinuma method can serve as a novel and viable NTR procedure for POP.
摘要：
背景：使用网状物的腹腔镜骶结肠切除术（LSC）和机器人辅助骶结肠切除术（RSC）是治疗盆腔器官脱垂（POP）的流行方法。然而,对于预期存在广泛腹膜内粘连的患者或由于各种危险因素导致LSC或RSC困难的患者,天然组织修复(NTR)作为一种选择并不少见.腹腔镜阴道残端-子宫骶韧带固定术（Shull方法）已被引入作为POP的NTR方法。然而,在严重的持久性有机污染物中，可能无法使用这种外科手术进行有效的修复。为了解决Shull方法的问题，我们设计了腹腔镜阴道残端-圆韧带固定术（Kakinuma方法），其中阴道残端固定在子宫圆韧带上，在解剖学上比子宫骶韧带高的组织学组织。本研究旨在回顾性和临床比较这两种方法。
方法：在2017年1月至2022年6月期间接受POP手术并术后随访至少一年的78例患者中，回顾性分析40例接受Shull方法（Shull组）和38例接受Kakinuma方法（Kakinuma组）的患者。
结果：两组患者背景变量，如平均年龄，奇偶校验，身体质量指数,和POP-Q阶段。Shull组平均手术时间和平均失血量分别为140.5±31.7min和91.3±96.3ml,分别,而Kakinuma组的相应值分别为112.2±25.3分钟和31.4±47.7毫升，分别。因此，与舒尔集团相比，Kakinuma组手术时间明显缩短(P<0.001),失血量明显减少(P=0.003).在Shull组中有6例患者（15.0％）和Kakinuma组中有2例患者（5.3％）复发。因此，与舒尔集团相比，Kakinuma组的复发率明显较低(P=0.015).两组患者均未出现围手术期并发症。
结论：结果表明，Kakinuma方法可以作为POP的一种新颖可行的NTR方法。
方法：在2017年1月至2022年6月期间接受POP手术并术后随访至少一年的78例患者中，回顾性分析40例接受Shull方法（Shull组）和38例接受Kakinuma方法（Kakinuma组）的患者。
结果：两组患者背景变量，如平均年龄，奇偶校验，身体质量指数,和POP-Q阶段。Shull组平均手术时间和平均失血量分别为140.5±31.7min和91.3±96.3ml,分别,而Kakinuma组的相应值分别为112.2±25.3分钟和31.4±47.7毫升，分别。因此，与舒尔集团相比，Kakinuma组手术时间明显缩短(P<0.001),失血量明显减少(P=0.003).在Shull组中有6例患者（15.0％）和Kakinuma组中有2例患者（5.3％）复发。因此，与舒尔集团相比，Kakinuma组的复发率明显较低(P=0.015).两组患者均未出现围手术期并发症。
结论：结果表明，Kakinuma方法可以作为POP的一种新颖可行的NTR方法。
