生殖器裂孔测量预测脱垂手术中袖带脱垂的风险

F. Şahin, Ramazan Adan, Neslihan Bademler, Elif Akkoç Demirel, Murat İbrahim Toplu, V. Mihmanlı
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引用次数: 0

摘要

背景/目的:在脱垂的评估和管理中,识别和评估阴道根尖支持缺陷仍然是一个重大挑战,因为没有共识或指南来解决根尖支持损失的程度,在这种程度上应该常规进行根尖支持手术。本研究的目的是评估术前生殖器间隙(GH)、会阴体(PB)和阴道总长度(TVL)是否与根尖脱垂手术后脱垂复发有关。方法:我们的队列研究纳入了98例根据2020年至2021年盆腔器官脱垂量化(POP-Q)分期为2级或以上的子宫阴道脱垂而行阴道子宫切除术根尖悬吊的患者。排除有妇科恶性肿瘤病史者、不能耐受手术或麻醉者、既往行盆腔器官脱垂手术者、合并应激性尿失禁者、宫颈涂片结果异常者。术后第一年每隔3个月随访2年。最后一次POP-Q是在手术干预后24个月。手术失败或复发被定义为根尖下降超过阴道总长度的三分之一,阴道前壁或后壁超过处女膜,随后的手术,或令人烦恼的阴道隆起。术前及术后6个月给予盆腔器官脱垂症状评分(POP-SS)问卷,比较有无术后复发组的症状严重程度。采用Logistic回归(LR)分析确定影响复发的因素。计算ROC曲线下的面积作为是否存在复发的鉴别诊断,并通过敏感性、特异性、阳性预测值、阴性预测值和LR(+)值确定变量的预测值(截止值)。结果:80例患者手术成功,18例患者生殖器复发。术前会阴体平均3.05 (0.28)cm, GH平均3.9 (0.39)cm, TVL平均8.54 (1.33)cm。复发组的平均GH显著高于未复发组(P=0.004)。术前平均POP-SS评分15.14分(1.86分),术后平均POP-SS评分4.01分(3.74分)。术后复发(+)组的POP-SS评分均值显著高于无复发组(P4 cm敏感性61.11%,特异性76.25%,阳性预测值36.70%,阴性预测值89.70%,LR(+)值2.57)。对于POP-SS术前-术后改变%,截点4cm是顶端支持损失的有力预测指标。这个简单的测量可以用来筛选根尖支持损失和进一步评估根尖阴道支持计划子宫切除术或脱垂手术之前。
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Genital hiatus measurements predict cuff prolapse risk in prolapse surgery
Background/Aim: Recognition and assessment of apical vaginal support defects remains a significant challenge in the evaluation and management of prolapse because there are no consensus or guidelines address the degree of apical support loss at which an apical support procedure should routinely be performed. The aim of this study was to evaluate whether preoperative genital hiatus (GH), perineal body (PB), and total vaginal length (TVL) are associated with prolapse recurrence after apical prolapse surgery. Methods: Our cohort study included 98 patients who underwent vaginal hysterectomy apical suspension due to uterovaginal prolapse of grade 2 or higher according to Pelvic Organ Prolapse Quantification (POP-Q) staging between 2020 and 2021. Patients with a history of gynecologic malignancy, those who could not tolerate surgery or anesthesia, those who had previously undergone pelvic organ prolapse surgery, those with concomitant stress urinary incontinence, and those with abnormal cervical smear results were excluded. Patients were followed for 2 years at intervals of 3 months in the first year after the surgery. The last POP-Q was performed 24 months after surgical intervention. Surgical failure or recurrence was defined as apical descent greater than one third of the total vaginal length, anterior or posterior vaginal wall past the hymen, subsequent surgery, or bothersome vaginal bulge. Patients were given the Pelvic Organ Prolapse Symptom Score (POP-SS) questionnaire before surgery and 6 months postoperatively, and the severity of symptoms was compared between the groups with and without postoperative recurrence. Logistic regression (LR) analysis was performed to determine the factors affecting recurrence. Areas under the ROC curve were calculated as a differential diagnosis for the presence of recurrence, and the predictive value (cut-off) of variables was determined using sensitivity, specificity, positive predictive value, negative predictive value, and LR (+) values. Results: While surgery was successful in 80 patients, genital relapse was seen in 18 patients. The mean preoperative perineal body was 3.05 (0.28) cm, mean preoperative GH was 3.9 (0.39) cm, and mean preoperative TVL was 8.54 (1.33) cm. The mean GH of the group with recurrence was significantly higher than the group without recurrence (P=0.004). The mean preoperative POP-SS score was 15.14 (1.86), and the postoperative POP-SS score was 4.01 (3.74). The postoperative POP-SS score mean of the recurrence (+) group was significantly higher than the group without recurrence (P<0.001). For the genital hiatus, the cut-off >4 cm had a sensitivity of 61.11%, specificity of 76.25%, positive predictive value of 36.70%, negative predictive value of 89.70%, and LR (+) value of 2.57. For POP-SS Preop-Postop Change %, the cut-off <60 had a sensitivity of 94.44%, specificity of 98.75%, positive predictive value of 94.40%, negative predictive value of 98.80%, and LR (+) value of 75.56. Conclusion: Apical vaginal support loss is highly associated with genital hiatus size. In particular, according to all study definitions, a Pelvic Organ Prolapse-Quantification measurement genital hiatus of >4 cm is a strong predictor of apical support loss. This simple measurement can be used to screen for apical support loss and further evaluate apical vaginal support before planning a hysterectomy or prolapse surgery.
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