Comiter C V, Vasavada S P, Raz S
Department of Urology, University of California, Los Angeles, USA.
Urology. 1999 Nov;54(5):819-22. doi: 10.1016/s0090-4295(99)00266-6.
Numerous techniques have been described for supporting the vaginal vault after enterocele repair and hysterectomy. We describe a transvaginal culdosuspension that obliterates the cul-de-sac and supports the vaginal cuff high on the levator plate. The normal vaginal axis is restored, and adequate vaginal depth is provided for normal sexual activity.
One hundred four patients, aged 48 to 90 years (mean age 71), underwent transvaginal culdosuspension in conjunction with enterocele repair (62 patients), vaginal hysterectomy (20 patients), or both (22 patients). Two culdosuspension sutures support the vaginal vault to the origin of the sacrouterine and cardinal ligaments, and the cul-de-sac is obliterated with two pursestring sutures. Concomitant prolapse was repaired in 82 patients, bladder neck suspension in 50, cystocele repair in 45, and rectocele repair in 76.
One hundred patients were followed up at a mean of 17.3 months (range 6.5 to 35). Recurrence of enterocele or vault prolapse occurred in 4 patients. All patients who had preoperative stress incontinence were cured of leakage. Complications were rare, and there were no instances of vaginal foreshortening, urinary retention, vaginal skin necrosis, bladder perforation, or rectovaginal fistula.
Transvaginal culdosuspension is a safe and effective procedure for treating and preventing enterocele and vaginal vault prolapse. This technique restores the normal vaginal depth and axis, resulting in a sexually functional vagina.
对于肠膨出修补术和子宫切除术后阴道穹窿的支撑，已有多种技术被描述。我们描述了一种经阴道直肠固定术，该手术可封闭直肠子宫陷凹，并在肛提肌板较高位置支撑阴道断端。恢复了正常的阴道轴，并为正常的性行为提供了足够的阴道深度。
104例年龄在48至90岁（平均年龄71岁）的患者接受了经阴道直肠固定术，其中62例患者同时进行了肠膨出修补术，20例患者进行了阴道子宫切除术，22例患者两者同时进行。两根直肠固定缝线将阴道穹窿支撑至骶子宫韧带和主韧带的起始处，并用两根荷包缝线封闭直肠子宫陷凹。82例患者同时修复了伴随的脱垂，50例患者进行了膀胱颈悬吊术，45例患者进行了膀胱膨出修补术，76例患者进行了直肠膨出修补术。
100例患者接受了平均17.3个月（范围6.5至35个月）的随访。4例患者出现肠膨出或穹窿脱垂复发。所有术前有压力性尿失禁的患者漏尿均得到治愈。并发症罕见，未出现阴道缩短、尿潴留、阴道皮肤坏死、膀胱穿孔或直肠阴道瘘的情况。
经阴道直肠固定术是治疗和预防肠膨出及阴道穹窿脱垂的一种安全有效的手术方法。该技术恢复了正常的阴道深度和轴，从而形成具有性功能的阴道。
