Karram M, Goldwasser S, Kleeman S, Steele A, Vassallo B, Walsh P
Division of Urogynecology and Reconstructive Pelvic Surgery, Good Samaritan Hospital, University of Cincinnati, Ohio, USA.
Am J Obstet Gynecol. 2001 Dec;185(6):1339-42; discussion 1342-3. doi: 10.1067/mob.2001.119077.
The purpose of this study was to review retrospectively the functional and anatomic outcomes of women who underwent vaginal repair of enterocele and vault prolapse with the use of an intraperitoneal suspension of the vaginal vault to the uterosacral ligaments in conjunction with fascial reconstruction of the anterior and posterior vaginal wall.
Two hundred two women with advanced symptomatic uterovaginal prolapse or posthysterectomy vault prolapse underwent a standard transvaginal procedure to correct their prolapse between January 1997 and June 2000. Anatomic results were assessed by standardized examination from 6 months to 3 years after the operation. Functional results were assessed subjectively and with standard quality of life questionnaires. The average age of the women was 60.3 years. Follow-up data were available for 168 of the 202 women. Fifty-three percent of the women had their uterus in place and underwent a vaginal hysterectomy. The prolapse repair was a primary procedure in 45.2% of the women and was performed for a recurrence or persistence in 54.8% of the women. Sixty percent and 78.6% of women underwent anterior and posterior repair, respectively. Thirty-five percent of the women underwent an anti-incontinence procedure.
Eighty-nine percent of the women expressed satisfaction with the results of the procedure. Ten women (5.5%) underwent a repeat operation (by the authors) for recurrence of prolapse in one or more segments of the pelvic floor. Quality of life assessment revealed a significant reduction in all aspects of daily living, when the short forms of the incontinence impact questionnaire and urogenital distress inventory were evaluated before and after the operation. Major intraoperative complications included 5 cases (2.4%) of ureteral injury, 1 case of a small bowel injury, and 1 case of a pelvic abscess that required abdominal exploratory operation and diversion of the colon.
High uterosacral ligament vaginal vault suspension with fascial reconstruction would seem to provide a durable anatomic repair with good functional improvement in patients with significant complex uterine or vaginal vault prolapse.
本研究的目的是回顾性分析接受阴道穹窿经腹膜悬吊至子宫骶韧带联合阴道前壁和后壁筋膜重建术治疗肠膨出和穹窿脱垂的女性的功能和解剖学结局。
1997年1月至2000年6月期间，202例有症状的晚期子宫阴道脱垂或子宫切除术后穹窿脱垂的女性接受了标准经阴道手术以纠正脱垂。术后6个月至3年通过标准化检查评估解剖学结果。通过主观评估和标准生活质量问卷评估功能结果。这些女性的平均年龄为60.3岁。202例女性中有168例有随访数据。53%的女性子宫保留原位并接受了阴道子宫切除术。45.2%的女性脱垂修复为初次手术，54.8%的女性因复发或持续存在而进行修复。分别有60%和78.6%的女性接受了前壁和后壁修复。35%的女性接受了抗尿失禁手术。
89%的女性对手术结果表示满意。10例女性（5.5%）因盆底一个或多个节段脱垂复发接受了再次手术（由作者进行）。生活质量评估显示，在使用尿失禁影响问卷简表和泌尿生殖系统困扰量表对手术前后进行评估时，日常生活的各个方面均有显著改善。主要术中并发症包括5例（2.4%）输尿管损伤、1例小肠损伤和1例盆腔脓肿，后者需要进行腹部探查手术并结肠改道。
高位子宫骶韧带阴道穹窿悬吊联合筋膜重建似乎能为患有严重复杂子宫或阴道穹窿脱垂的患者提供持久的解剖学修复，并带来良好的功能改善。
