Carter J E
Women's Health Center of South Orange County, Inc., Mission Viejo, California, USA.
J Reprod Med. 1999 May;44(5):417-22.
To describe a technique and results of uterine suspension and positioning by extraperitoneal ligament investment, fixation and truncation (UPLIFT).
Seventy-five women aged 19-48 years in a private referral center with chronic pelvic pain, dyspareunia and dysmenorrhea seeking treatment were evaluated and treated over a two-year period. Laparoscopic uterine suspension was performed using the Carter-Thomason 2-mm needle point suture passer. The instrument was passed within and along the round ligament. Thus, a pledget of round ligament and bridge of fascial tissue were created. Performing the uterine suspension procedure in this manner created shortened, thickened and strengthened ligaments that suspended the uterine fundus securely in a mildly anteverted position at the level of the exit point of the round ligaments through the inguinal canal.
The procedure was performed without complications in 75 patients over a two-year span. Each patient was evaluated for degree of retroversion and was assessed by ultrasound to identify any uterine or ovarian abnormalities. Pelvic pain and dyspareunia were reproduced by palpation of the retroverted uterus. The procedure took an average of 12 minutes to perform. All procedures were performed as outpatient procedures with same-day discharge, and there were no intraoperative complications. Delayed postoperative pain at the suspension site significant enough to require oral analgesia or injection with local anesthesia occurred in five patients (7%), four for one week and one for one month. For all 75 patients the pain with menses decreased from 8.4 to 1.7, with 0 being no pain and 10 being the worst pain the patient had ever experienced (P < .01, Wilcoxon's Signed Rank Test). Pain with intercourse decreased from 8.1 to 1.5 (P < .01, Wilcoxon's Signed Rank Test). Sixty-three patients (84%) reported essentially no pain (0-2), while 5 (7%) reported mild pain (2-5), 3 (4%) reported moderate pain (5-7), and 4 (5%) continued to have the pain that they had had before the surgery (8-10). For the 20 patients for whom a retroverted uterus was the only significant pathologic finding, 18 of these (90%) had immediate and sustained relief from their symptoms.
When dyspareunia, dysmenorrhea and pelvic pain are associated with a retroverted uterus, the uterus can be repositioned to a slightly anteverted position by UPLIFT with the Carter-Thomason needle point suture passer. Results with this anatomically correct technique are consistent with those previously given for other uterine suspension procedures. The advantages of this procedure are ease of performance, strengthening of the ligaments by shortening and the investment procedure, and a repair that maintains normal anatomic relationships.
描述经腹膜外韧带包埋、固定和截断的子宫悬吊及复位技术（UPLIFT）及其结果。
在一家私立转诊中心，对75名年龄在19 - 48岁、患有慢性盆腔疼痛、性交困难和痛经并寻求治疗的女性进行了为期两年的评估和治疗。使用卡特 - 托马森2毫米针尖缝合器进行腹腔镜子宫悬吊术。该器械经圆韧带内部并沿其走行穿过。由此，形成了一块圆韧带组织块和筋膜组织桥。以这种方式进行子宫悬吊手术可使韧带缩短、增厚并加强，从而将子宫底牢固地悬吊在圆韧带通过腹股沟管出口水平的轻度前倾位置。
在两年时间里，75例患者手术均无并发症。对每位患者评估子宫后倾程度，并通过超声检查以确定是否存在子宫或卵巢异常。通过触诊后倾子宫再现盆腔疼痛和性交困难。手术平均耗时12分钟。所有手术均作为门诊手术，患者当日出院，术中无并发症。5例患者（7%）术后在悬吊部位出现延迟性疼痛，严重到需要口服镇痛药或局部麻醉注射，其中4例持续一周，1例持续一个月。对于所有75例患者，月经疼痛评分从8.4降至1.7（0表示无疼痛，10表示患者经历过的最严重疼痛，Wilcoxon符号秩和检验，P <.01）。性交疼痛评分从8.1降至1.5（Wilcoxon符号秩和检验，P <.01）。63例患者（84%）报告基本无疼痛（0 - 2分），5例（7%）报告轻度疼痛（2 - 5分），3例（4%）报告中度疼痛（5 - 7分），4例（5%）仍有术前的疼痛（8 - 10分）。对于20例子宫后倾是唯一显著病理发现的患者，其中18例（90%）症状立即且持续缓解。
当性交困难、痛经和盆腔疼痛与子宫后倾相关时，可使用卡特 - 托马森针尖缝合器通过UPLIFT技术将子宫复位至轻度前倾位置。这种解剖学上正确的技术结果与先前其他子宫悬吊手术的结果一致。该手术的优点包括操作简便，可以通过缩短和包埋过程加强韧带，以及修复过程维持了正常的解剖关系。
