近日，荷兰伊萨拉医院妇产科教授Hugo W F van Eijndhoven及其研究团队，研究比较了骶棘韧带悬吊术与阴式子宫切除子宫骶韧带悬吊术治疗子宫脱垂2期及以上的临床效果。 该项研究成果2019年9月10日在线发表于《英国医学期刊》。

子宫脱垂是一种常见的健康问题，由于人口老龄化和肥胖率上升，发病率持续增加。女性进行脱垂手术的终身风险为11-20％，全世界治疗子宫脱垂最常见的当属阴式子宫切除术。

2009-2012年，荷兰的四所非教学医院招募了208名健康女性，其中204名患有子宫脱垂2期及以上，需要手术。所有参与者均没有盆底手术史，她们随机分组接受保留子宫的骶棘韧带悬吊术或阴式子宫切除子宫骶韧带悬吊术。术后每年进行随访，共随访五年。综合成功定义为没有处女膜外脱垂，阴道无膨出症状，无需重复手术或复发性脱垂治疗。

手术5年后，骶棘韧带悬吊术组中有1名（1%）女性手术失败，阴道有烦人的块状物膨出且需要再次手术，阴式子宫切除子宫骶韧带悬吊术组中有8例（7.8%）女性手术失败且有同样症状，差异为-6.7%。骶棘韧带悬吊术组的综合成功率为87%，显著高于阴式子宫切除子宫骶韧带悬吊术组（76%）。五年的时间-事件分析显示干预措施没有差异。

经过5年的随访发现，骶棘韧带悬吊术与阴式子宫切除子宫骶韧带悬吊术相比，显著降低了中盆腔室的解剖复发率，阴道无膨出，无需再次手术，提高了手术的综合成功率。

附：英文原文

Title: Sacrospinous hysteropexy versus vaginal hysterectomy with uterosacral ligament suspension in women with uterine prolapse stage 2 or higher: observational follow-up of a multicentre randomised trial

Author: Sascha F M Schulten, Renée J Detollenaere, Jelle Stekelenburg, Joanna IntHout, Kirsten B Kluivers, Hugo W F van Eijndhoven

Issue&Volume: 2019/09/10

Abstract: 

Objective To evaluate the effectiveness and success of uterus preserving sacrospinous hysteropexy as an alternative to vaginal hysterectomy with uterosacral ligament suspension in the surgical treatment of uterine prolapse five years after surgery.

Design Observational follow-up of SAVE U (sacrospinous fixation versus vaginal hysterectomy in treatment of uterine prolapse ≥2) randomised controlled trial.

Setting Four non-university teaching hospitals, the Netherlands.

Participants 204 of 208 healthy women in the initial trial (2009-12) with uterine prolapse stage 2 or higher requiring surgery and no history of pelvic floor surgery who had been randomised to sacrospinous hysteropexy or vaginal hysterectomy with uterosacral ligament suspension. The women were followed annually for five years after surgery. This extended trial reports the results at five years.

Main outcome measures Prespecified primary outcome evaluated at five year follow-up was recurrent prolapse of the uterus or vaginal vault (apical compartment) stage 2 or higher evaluated by pelvic organ prolapse quantification system in combination with bothersome bulge symptoms or repeat surgery for recurrent apical prolapse. Secondary outcomes were overall anatomical failure (recurrent prolapse stage 2 or higher in apical, anterior, or posterior compartment), composite outcome of success (defined as no prolapse beyond the hymen, no bothersome bulge symptoms, and no repeat surgery or pessary use for recurrent prolapse), functional outcome, quality of life, repeat surgery, and sexual functioning.

Results At five years, surgical failure of the apical compartment with bothersome bulge symptoms or repeat surgery occurred in one woman (1%) after sacrospinous hysteropexy compared with eight women (7.8%) after vaginal hysterectomy with uterosacral ligament suspension (difference−6.7%, 95% confidence interval −12.8% to−0.7%). A statistically significant difference was found in composite outcome of success between sacrospinous hysteropexy and vaginal hysterectomy (89/102 (87%) v 77/102 (76%). The other secondary outcomes did not differ. Time-to-event analysis at five years showed no differences between the interventions.

Conclusions At five year follow-up significantly less anatomical recurrences of the apical compartment with bothersome bulge symptoms or repeat surgery were found after sacrospinous hysteropexy compared with vaginal hysterectomy with uterosacral ligament suspension. After hysteropexy a higher proportion of women had a composite outcome of success. Time-to-event analysis showed no differences in outcomes between the procedures.

DOI: 10.1136/bmj.l5149

Source: https://www.bmj.com/content/366/bmj.l5149