Cosson M, Bogaert E, Narducci F, Querleu D, Crépin G
Pôle de chirurgie gynécologique, Hôpital Jeanne-de-Flandres, CHRU Lille, Université Lille II, France.
J Gynecol Obstet Biol Reprod (Paris). 2000 Dec;29(8):746-750.
We retrospectively studied 77 laparoscopic sacral colpopexies performed from June 1996 to May 1998. Suspension was reinforced with two strips of synthetic mesh. Five patients had previously undergone hysterectomy and 4 others had experienced failure of surgery for prolapse of the uterus. Laparoscopy was performed in 83 women with symptomatic prolapse of the uterus. Six cases required conversion to laparotomy because of technical difficulties. All other 77 patients underwent laparoscopic sacropexy using anterior and posterior mesh reinforcement. Subtotal laparoscopic hysterectomy was associated in 60 cases, laparoscopic Burch colposuspension in 74 and levator myorraphy using the vaginal approach in 55. Operative time decreased from 292 to 180 minutes as the surgeon gained experience. The main operative complications were one rectal and two bladder injuries. Three patients required reoperations for haematoma or hemorrhage. One patient complained of chronic inflammation of the cervix and another experienced rejection of the posterior mesh 6 months after the operation. Mean follow up was 343 days. Three other patients required reoperation: one for a 3(rd) degree cystocele and two for recurrent stress incontinence. The conclusion of this study is that laparoscopic sacrocolpopexy is feasible. Operative time and postoperative complications are related to the surgeon's experience but remain comparable to those noted in laparotomy. Long term assessment is required to confirm the results of this procedure.
我们回顾性研究了1996年6月至1998年5月期间进行的77例腹腔镜骶骨阴道固定术。用两条合成网片加强悬吊。5例患者此前接受过子宫切除术,另外4例患者曾因子宫脱垂手术失败。对83例有症状的子宫脱垂女性进行了腹腔镜检查。6例因技术困难需要转为开腹手术。其他77例患者均采用前后网片加强的腹腔镜骶骨固定术。60例患者同时进行了腹腔镜次全子宫切除术,74例进行了腹腔镜Burch阴道悬吊术,55例采用阴道入路进行了提肛肌修补术。随着外科医生经验的增加,手术时间从292分钟减少到180分钟。主要手术并发症为1例直肠损伤和2例膀胱损伤。3例患者因血肿或出血需要再次手术。1例患者抱怨宫颈慢性炎症,另1例患者术后6个月出现后网片排斥反应。平均随访343天。另外3例患者需要再次手术:1例因三度膀胱膨出,2例因复发性压力性尿失禁。本研究的结论是腹腔镜骶骨阴道固定术是可行的。手术时间和术后并发症与外科医生的经验有关,但仍与开腹手术中观察到的情况相当。需要进行长期评估以证实该手术的结果。