Nguyen J K
Department of Obstetrics and Gynecology, Kaiser Foundation Hospital, Bellflower, California 90242, USA.
Obstet Gynecol Surv. 2001 Apr;56(4):239-46. doi: 10.1097/00006254-200104000-00025.
Anterior vaginal prolapse is often caused by defects in the paravaginal fascia. The purpose of this article is to review the current concepts in the diagnosis and surgical repair of anterior vaginal prolapse due to paravaginal defects. Articles related to paravaginal defects were identified through a MEDLINE search of English-language medical journals published between June 1909 and August 2000. Physical examination is usually used to diagnose paravaginal defects, but this method may have low specificity and low positive predictive value. Magnetic resonance imaging may be used to examine the pelvic anatomy, but it is expensive and may not be readily available to all physicians. Transabdominal ultrasound does not appear to be useful for detection of paravaginal defects. Paravaginal repair, both transvaginal and transabdominal approaches, appears to offer favorable cure rates and low recurrence rates of anterior vaginal prolapse. Paravaginal repair does not appear to be as effective as Burch colposuspension for treatment of stress urinary incontinence. The efficacy of laparoscopic paravaginal repair requires additional investigation. Complications including voiding dysfunction, hemorrhage, and urinary tract injury are uncommon. The long-term efficacy of paravaginal repair requires further investigation.
阴道前壁脱垂常由阴道旁筋膜缺陷引起。本文旨在综述因阴道旁缺陷导致的阴道前壁脱垂的诊断及手术修复的当前概念。通过对1909年6月至2000年8月期间发表的英文医学期刊进行MEDLINE检索，确定了与阴道旁缺陷相关的文章。体格检查通常用于诊断阴道旁缺陷，但该方法可能特异性低且阳性预测值低。磁共振成像可用于检查盆腔解剖结构，但费用昂贵，并非所有医生都能轻易获得。经腹超声似乎对检测阴道旁缺陷无用。经阴道和经腹途径的阴道旁修复术，对阴道前壁脱垂似乎都有良好的治愈率和低复发率。阴道旁修复术在治疗压力性尿失禁方面似乎不如Burch阴道悬吊术有效。腹腔镜阴道旁修复术的疗效需要进一步研究。包括排尿功能障碍、出血和尿路损伤在内的并发症并不常见。阴道旁修复术的长期疗效需要进一步研究。
