Reisenauer Christl, Kirschniak Andreas, Drews Ulrich, Wallwiener Diethelm
Department of Obstetrics and Gynecology, University of Tuebingen, Calwerstrasse 7, 72076 Tuebingen, Germany.
Eur J Obstet Gynecol Reprod Biol. 2007 Apr;131(2):214-25. doi: 10.1016/j.ejogrb.2006.03.020. Epub 2006 May 3.
The purpose of the surgical treatment of vaginal prolapse is not only the restoration of the anatomy but also of the visceral functioning. To maintain the quality of life for patients with recurrent vaginal prolapse, to reduce the failure rates of operations and to avoid a colpectomy or a colpocleisis at the same time, synthetic materials have been introduced in transvaginal reconstructive surgery of the pelvic floor. The TVM Group from France described the reconstruction of the pelvic floor with polypropylene implants in 2004. The aim of this study is to determine the anatomical position of the polypropylene implants after reconstruction of each compartment of the pelvic floor and to determine the relation of the implants to the major neighbouring neurovascular structures on the basis of corpse dissections.
Following the technique of the TVM Group from France we present the pelvic floor reconstruction using Gynecare Prolift* (Ethicon, Sommerville, NJ, USA). To reach the aims of the study, anatomical dissections of the pelvic floor on three specially preserved anatomical specimens are performed after the placement of the implants.
The anatomical dissections show that every defect in all three compartments of the pelvic floor can be repaired by using polypropylene implants. Between the implants and the major neighbouring neurovascular structures a safe distance exists with slight individual differences.
The pelvic floor reconstruction using polypropylene implants is a treatment option especially for the surgical correction of the recurrent vaginal prolapse. If the surgeon has thorough anatomical knowledge and performs the surgical technique in the recommended manner, injuries of the major neighbouring neurovascular structures will be avoided. Clinical studies will analyze the long-term results after pelvic floor reconstruction using polypropylene implants.
阴道脱垂手术治疗的目的不仅是恢复解剖结构，还要恢复内脏功能。为维持复发性阴道脱垂患者的生活质量、降低手术失败率并避免同时进行阴道切除术或阴道闭合术，合成材料已被引入盆底经阴道重建手术。法国的TVM团队在2004年描述了使用聚丙烯植入物进行盆底重建。本研究的目的是在尸体解剖的基础上，确定盆底各腔室重建后聚丙烯植入物的解剖位置，并确定植入物与主要相邻神经血管结构的关系。
按照法国TVM团队的技术，我们展示使用吉妮致美（美国新泽西州萨默维尔市Ethicon公司）进行盆底重建。为达到研究目的，在植入物放置后，对三个特殊保存的解剖标本进行盆底解剖。
解剖显示，使用聚丙烯植入物可修复盆底所有三个腔室的每一处缺损。植入物与主要相邻神经血管结构之间存在安全距离，个体差异较小。
使用聚丙烯植入物进行盆底重建是一种治疗选择，尤其适用于复发性阴道脱垂的手术矫正。如果外科医生具备扎实的解剖学知识并以推荐方式实施手术技术，可避免损伤主要相邻神经血管结构。临床研究将分析使用聚丙烯植入物进行盆底重建后的长期效果。
