目的:为盆腔脏器前肢手术中子宫切除术的临床实践提供指导,有或没有网眼。
方法:系统回顾有关盆腔器官前肢手术中子宫保留或子宫切除术的解剖和功能结果的文献。
结果:在回顾性比较研究和荟萃分析中,骶棘子宫固定术与阴式子宫切除术和修补术一样有效,手术时间缩短。失血量和恢复时间(NP2)。然而,与阴式子宫切除术相比,在单次RCT中,骶棘子宫切除术的复发率较高.骶棘子宫固定术联合前房室网片增加与子宫切除术和网片增加(NP2)一样有效,各组间网孔暴露率(NP3)无显著差异。骶骨子宫切除术在解剖学结果上与骶骨结肠切除术和子宫切除术一样有效;然而,骶骨结肠切除术和子宫切除术与增加手术时间和失血量(NP1)相关。与不进行子宫切除术(NP3)的骶骨结肠切除术相比,在骶骨结肠切除术中进行子宫切除术与网状物暴露的风险更高。文献中没有足够的数据来确认子宫保护改善性功能(NP3)。
结论:虽然保留子宫是子宫脱垂手术治疗的可行选择,但目前缺乏关于安全性和有效性的证据。©2016由ElsevierMassonSAS发布。
OBJECTIVE: Provide
guidelines for clinical practice concerning hysterectomy during surgical treatment of pelvic organ prolaps, with or without mesh.
METHODS: Systematically review of the literature concerning anatomical and functionnal results of uterine conservation or hysterectomie during surgical treatment of pelvic organ prolaps.
RESULTS: Sacrospinous hysteropexy is as effective as vaginal hysterectomy and repair in retrospective comparative studies and in a meta-analysis with reduced operating time, blood loss and recovery time (NP2). However, in a single RCT there was a higher recurrence rate associated with sacrospinous hysteropexy compared with vaginal hysterectomy. Sacrospinous hysteropexy with mesh augmentation of the anterior compartment was as effective as hysterectomy and mesh augmentation (NP2), with no significant difference in the rate of mesh exposure between the groups (NP3). Sacral hysteropexy is as effective as sacral colpopexy and hysterectomy in anatomical outcomes; however, the sacral colpopexy and hysterectomy were associated with increase operating time and blood loss (NP1). Performing hysterectomy at sacral colpopexy was associated with a higher risk of mesh exposure compared with sacral colpopexy without hysterectomy (NP3). There is no sufficient data in the literature to affirm that the uterine conservation improve sexual function (NP3).
CONCLUSIONS: While uterine preservation is a viable option for the surgical management of uterine prolapse the evidence on safety and efficacy is currently lacking. © 2016 Published by Elsevier Masson SAS.