背景:预计到2050年,医学进步将导致80岁及以上女性人口的大幅增加。因此,大量接受脱垂矫正手术的患者将属于老年患者类别。研究表明,无论虚弱和其他危险因素如何,80岁以上的患者与脱垂手术相关的并发症显着增加。尽管面临这些挑战,阴道入路已被确定为老年人盆腔器官脱垂(POP)修复最安全的手术方法。出于这个原因,我们的目的是调查疗效,并发症发生率,以及与阴式子宫切除术和根尖悬吊术/子宫骶韧带高位悬吊术作为脱垂修复的主要技术相关的功能结果,都在一组老年患者中。
方法:我们回顾性分析了2006年1月至2013年12月期间经阴道子宫切除术加根尖悬吊术治疗≥II期和有症状的生殖器脱垂的患者。评估解剖学和功能结果。患者总体改善印象(PGI-I)评分用于评估手术后的主观满意度。
结果:65例患者纳入分析。中位年龄为81.3岁。所有患者均表现为II期或更高前室脱垂,大多数也是中央脱垂II期或更高。值得注意的是,所有参与者均报告了阴道膨出的症状.超过一半的人口(58.6%)抱怨膀胱排空不完全。对所有参与者的干预包括阴式子宫切除术和根尖悬吊术。63例患者(96.9%)和44例患者(67.6%)同时进行了前后修复,分别。随访期间观察到长期并发症(手术后>30天),中位持续时间为23±20个月。记录了7次(10.7%)解剖复发,五个(7.69%)关于前室,一个(1.5%)中央,和三个(4.6%)后面。然而,由于症状,他们都不需要进一步的手术干预。前牙的解剖学改善显著,中央,和后隔室被注意到,与术前评估相比(Aa和Ba的p<0.001,Ap和Bp的p<0.001,对于C,p<0.001)。PGI-I值确定100%的患者满意(PGI-I≥2),中位数为1.12分。因此,客观和主观治愈率分别为89.5%和100%,分别。
结论:阴式子宫切除术联合根尖悬吊术,特别是高子宫骶韧带悬吊,是一种安全有效的初级手术方法,即使是老年患者。
BACKGROUND: Medical advancements are expected to lead to a substantial increase in the population of women aged 80 and older by 2050. Consequently, a significant number of individuals undergoing corrective prolapse surgery will fall into the elderly-patient category. The research indicates a notable rise in complications associated with prolapse surgery in patients older than 80, irrespective of frailty and other risk factors. Despite these challenges, the vaginal approach has been identified as the safest surgical method for pelvic organ prolapse (POP) repair in the elderly population. For this reason, we aimed to investigate the efficacy, complication rate, and functional outcomes associated with vaginal hysterectomy and an apical suspension/high uterosacral ligaments suspension as a primary technique for prolapse repair, both within a cohort of elderly patients.
METHODS: We retrospectively analyzed patients who underwent transvaginal hysterectomy plus an apical suspension procedure for stage ≥ II and symptomatic genital prolapse between January 2006 and December 2013. Anatomical and functional outcomes were evaluated. The Patient Global Impression of Improvement (PGI-I) score was used to evaluate subjective satisfaction after surgery.
RESULTS: Sixty-five patients were included in the analysis. The median age was 81.3 years. All individuals exhibited an anterior compartment prolapse stage II or higher, and the majority also a central prolapse stage II or higher. Notably, all participants reported symptoms of vaginal bulging. Over half of the population (58.6%) complained of incomplete bladder emptying. The intervention for all participants involved a vaginal hysterectomy with an apical suspension. Sixty-three patients (96.9%) and forty-four patients (67.6%) underwent a simultaneous anterior or posterior repair, respectively. Long-term complications (>30 days from surgery) were observed during follow-up, with a median duration of 23 ± 20 months. Seven (10.7%) anatomical recurrences were recorded, five (7.69%) concerning the anterior compartment, one (1.5%) the central, and three (4.6%) the posterior. Nevertheless, none of them necessitated further surgical intervention due to symptoms. Significant anatomical improvements for the anterior, central, and posterior compartments were noticed, compared to preoperative assessment (p < 0.001 for Aa and Ba, p < 0.001 for Ap and Bp, and p < 0.001 for C). PGI-I values established that 100% of patients were satisfied (PGI-I ≥ 2), with a median score of 1.12. Consequently, objective and subjective cure rates were 89.5% and 100%, respectively.
CONCLUSIONS: Vaginal hysterectomy combined with apical suspension, particularly high uterosacral ligaments suspension, is a safe and effective primary surgical approach, even in elderly patients.