背景:阴道前修补术(AC)是一种常规的膀胱膨出手术修复技术,但复发率高。我们提出了一种新技术:通过不可吸收的缝合线结合“桥”形成的电缆悬挂结构(CSS)在膀胱膨出的手术治疗中。本研究旨在评估和比较CSS技术用于AC阴道前壁修复的长期结果。
方法:对2012年1月至2017年3月在本中心接受阴道前壁修补术的患者进行回顾性分析。所有患者均接受随访调查。主要结果是客观治愈(前脱垂POP-Q≤1期)和主观治愈(无凸出症状或脱垂再治疗)。次要结果包括生活质量(QOL)和患者满意度,特定地点POP-Q点Aa的结果,Ba和C,以及术后并发症。
结果:在91名参与者中,43例接受AC,48例接受CSS。CSS组的肌棘韧带固定比例高于AC组(81.4%vs.77.1%,P<0.05)。在中位随访69个月时,CSS组的客观治愈率明显高于AC组(72.9%vs.51.2%,比值比2.57,95CI1.07-6.16)。在调整肌棘韧带固定后,CSS组仍然显示出更高的客观治愈率(调整比值比2.88,95CI1.16-7.21)。CSS组中POP-Q0期患者的比例尤其高于AC组(25%vs.7.0%,P=0.025)。两组在主观治愈方面没有差异,患者满意度和术后并发症。
结论:CSS技术显示出比AC更好的客观结果,然而,主观治愈率两者之间没有显著差异.未来的大规模前瞻性试验应该证实CSS在性活跃女性中的有效性和安全性。
Anterior colporrhaphy (AC) is a conventional surgical repair technique for
cystocele but with high recurrence rate. We present a novel technique: Cable-suspended structure (CSS) by non-absorbable suture combined with \"bridge\" formation in surgical treatment of
cystocele. This
study aimed to evaluate and compare the long-term outcome of CSS technique for anterior vaginal wall repair with AC.
A retrospective review was performed on patients who underwent anterior vaginal wall repair between January 2012 and March 2017 at our center. All the patients were under a follow-up survey. The primary outcomes were objective cure (anterior prolapse POP-Q ≤ stage 1) and subjective cure (no symptoms of bulge or retreatment for prolapse). Secondary outcomes included quality of life (QOL) and patients\' satisfaction, outcomes of site-specific POP-Q points Aa, Ba and C, as well as postoperative complications.
Of 91 included participants, 43 underwent AC and 48 underwent CSS. The proportion of sarcrospinous ligament fixation in the CSS group was higher than in the AC group (81.4% vs. 77.1%, P < 0.05). At a median follow-up of 69 months, the CSS group showed significantly higher objective cure rate compared with the AC group (72.9% vs. 51.2%, odds ratio 2.57, 95%CI 1.07-6.16). After adjusting for sarcrospinous ligament fixation, the CSS group still significantly showed higher objective cure rate (adjusted odds ratio 2.88, 95%CI 1.16-7.21). The proportion of the patients with POP-Q 0 stage in the CSS group was particularly higher than the AC group (25% vs. 7.0%, P = 0.025). There was no difference between the groups with respect to subjective cure, patients\' satisfaction and postoperative complication.
The CSS technique showed better objective outcome than AC, however, subjective cure rate did not significantly differ between the two. Future prospective
trial with large-scale should confirm the effectiveness and safety of CSS in sexually active women.