Argirović Rajka, Likić-Ladević Ivana, Vrzić-Petronijević Svetlana, Petronijević Milos, Ladević Nebojsa
Klinicki centar Srbije, Institut za ginekologiju i akuserstvo, Beograd, Srbija i Crna Gora.
Vojnosanit Pregl. 2005 Sep;62(9):637-43. doi: 10.2298/vsp0509637a.
The incidence of uterovaginal and vaginal vault prolapse appears to be higher due to the increased longevity of women. Sacrospinous ligament colpopexy is a surgery procedure which suspends the vagina up to the sacrospinous ligament and brings upper vagina over the levator plate. This technique is very useful for the primary treatment of uterovaginal prolapse in young women who want to preserve their fertility. The main aim of our study was to present the effectiveness of the us of this technique at our clinic, to investigate the possible intraoperative and postoperative complications of this technique, and to find out its effectiveness in the prevention of repeated vaginal vault prolapse.
Patients were treated with sacrospinous colpopexy with uterine conservation, vaginal hysterectomy with simultaneous sacrospinous colpopexy or obliteration of the enterocele sac, and sacrospinous colpopexy. Follow-up examinations of the patients we performed at 4 weeks, 6 months and 12 months after the surgery and yearly thereafter.
Thirty-seven women were treated with sacrospinous ligament suspension of vaginal vault. The 5 women had vault prolapse following the hysterectomy (the 3 of then had abdominal, and the 2 vaginal hysterectomy), and another 32 women had the various degrees of uterovaginal prolapse. We obtained satisfactory results in 33 patients, in the 3 we noticed asymptomatic cystocele, and the 1 (2.7%) had partial vaginal vault prolapse six months after the surgery. With regard to postoperative complications, 3 patients had Urination disturbance, 3 patients had urinary tract infection, 2 patients had febrile temperature, and the 2 patients had low back pain.
We performed sacrospinous fixation on the right side, and the postoperative results demonstrated no disturbance in vaginal axis and vault prolapse except in 1 patient. We had no intraoperative complications noted related to sacrospinous ligament colpopexy, such as the damage to the pudendal vessels and nerve, the sciatic nerve and rectum. The possibility of injury to the vessels and nearby nerves was preventid with the careful placement of suture through the sacrospinous ligament in the two fingerbreadths medial to its insertion in the ischial spine. In our series, we had 3 patients with conservation of the uterus. The 3 asymptomatic cystocele in our series were diagnosed 6 months after the operation. Our results were satisfactory, since we hade only one postoperative vault prolapse (2.7%).
The results of numerous studies, as well as the results of our study, showed that transvaginal sacrospinous colpopexy could be performed along with vaginal hysterectomy and the anterior and posterior vaginal wall repair in the patients with uterovaginal prolapse because of its high success in the prevention of postoperative vaginal vault prolapse and the low intra- and postoperative complication rates. This operative technique is successful in prevention of repeated vaginal vault prolapse.
由于女性寿命延长，子宫阴道脱垂和阴道穹隆脱垂的发病率似乎有所上升。骶棘韧带阴道固定术是一种将阴道悬吊至骶棘韧带并将阴道上段提升至肛提肌板上方的手术方法。该技术对于希望保留生育能力的年轻女性子宫阴道脱垂的初始治疗非常有用。我们研究的主要目的是展示该技术在我们诊所的应用效果，调查该技术可能的术中及术后并发症，并了解其在预防阴道穹隆脱垂复发方面的有效性。
患者接受保留子宫的骶棘韧带阴道固定术、同时进行骶棘韧带阴道固定术或封闭肠疝囊的阴道子宫切除术以及骶棘韧带阴道固定术。我们在术后4周、6个月和12个月以及此后每年对患者进行随访检查。
37名女性接受了阴道穹隆骶棘韧带悬吊术。5名女性在子宫切除术后出现穹隆脱垂（其中3例为经腹子宫切除术，2例为经阴道子宫切除术），另外32名女性有不同程度的子宫阴道脱垂。我们在33例患者中获得了满意的结果，3例患者发现无症状膀胱膨出，1例（2.7%）在术后6个月出现部分阴道穹隆脱垂。关于术后并发症，3例患者有排尿障碍，3例患者有尿路感染，2例患者发热，2例患者有腰痛。
我们在右侧进行了骶棘韧带固定术，除1例患者外，术后结果显示阴道轴和穹隆脱垂无异常。我们未发现与骶棘韧带阴道固定术相关的术中并发症，如阴部血管和神经、坐骨神经及直肠的损伤。通过在距骶棘韧带在坐骨棘附着点内侧两指宽处小心地穿过缝线，可避免血管和附近神经损伤。在我们的系列研究中，有3例患者保留了子宫。我们系列中的3例无症状膀胱膨出在术后6个月被诊断出来。我们的结果令人满意，因为我们仅有1例术后穹隆脱垂（2.7%）。
众多研究结果以及我们的研究结果表明，经阴道骶棘韧带阴道固定术可与阴道子宫切除术及阴道前后壁修补术一起用于子宫阴道脱垂患者，因为其在预防术后阴道穹隆脱垂方面成功率高，且术中及术后并发症发生率低。该手术技术在预防阴道穹隆脱垂复发方面是成功的。
