Winters J C, Cespedes R D, Vanlangendonck R
Department of Urology, Voiding Dysfunction and Reconstruction, Ochsner Clinic, Louisiana State University Medical Center, New Orleans, Louisiana, USA.
Urology. 2000 Dec 4;56(6 Suppl 1):55-63. doi: 10.1016/s0090-4295(00)00662-2.
Vaginal vault prolapse and enterocele represent challenging forms of female pelvic organ relaxation. These conditions are most commonly associated with other pelvic organ defects. Proper diagnosis and management is essential to achieve long-term successful outcomes. Physical examination should be carried out in the lithotomy and standing positions (if necessary) in order to detect a loss of vaginal vault support. With proper identification of the vaginal cuff, one should assess the degree of mobility of the vaginal cuff with a Valsalva maneuver. If there is significant descent of the vaginal cuff, vaginal vault prolapse is present, and correction should be considered. The abdominal sacral colpopexy is an excellent means to provide vaginal vault suspension. This procedure entails suspension of the vaginal cuff to the sacrum with fascia or synthetic mesh. This procedure should always be accompanied by an abdominal enterocele repair and cul-de-sac obliteration. In addition, many patients require surgical procedures to correct stress urinary incontinence, which is either symptomatic or latent (occurs postoperatively after prolapse correction). Complications include: mesh infection, mesh erosion, bowel obstruction, ileus, and bleeding from the presacral venous complex. If the procedure is carried out using meticulous technique, few complications occur and excellent long-term reduction of vaginal vault prolapse and enterocele are achieved. The purpose of this article is to review the preoperative evaluation of women with pelvic organ prolapse, and provide a detailed description of the surgical technique of an abdominal sacral colpopexy.
阴道穹窿脱垂和肠膨出是女性盆腔器官松弛的棘手形式。这些病症最常与其他盆腔器官缺陷相关。正确的诊断和治疗对于取得长期成功的治疗效果至关重要。体格检查应在截石位和必要时在站立位进行，以检测阴道穹窿支撑力的丧失。正确识别阴道袖口后，应通过瓦尔萨尔瓦动作评估阴道袖口的活动度。如果阴道袖口有明显下降，则存在阴道穹窿脱垂，应考虑进行矫正。腹骶阴道固定术是提供阴道穹窿悬吊的极佳方法。该手术需要用筋膜或合成网片将阴道袖口悬吊至骶骨。此手术应始终伴有腹部肠膨出修复和道格拉斯窝封闭。此外，许多患者需要手术来纠正压力性尿失禁，无论是有症状的还是潜在的（脱垂矫正术后出现）。并发症包括：网片感染、网片侵蚀、肠梗阻、肠麻痹和骶前静脉丛出血。如果手术采用精细技术进行，很少会出现并发症，并且能实现阴道穹窿脱垂和肠膨出的长期显著减轻。本文的目的是回顾盆腔器官脱垂女性的术前评估，并详细描述腹骶阴道固定术的手术技术。
