Silva W Andre, Pauls Rachel N, Segal Jeffrey L, Rooney Christopher M, Kleeman Steven D, Karram Mickey M
Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, Good Samaritan Hospital, Cincinnati, Ohio, USA.
Obstet Gynecol. 2006 Aug;108(2):255-63. doi: 10.1097/01.AOG.0000224610.83158.23.
To evaluate the five-year anatomic and functional outcomes of the high uterosacral vaginal vault suspension.
One hundred ten patients with advanced symptomatic uterovaginal or posthysterectomy prolapse treated between January 1997 and January 2000 were identified and 72 (65%) consented to participate in this study. Anatomic outcomes were obtained by Pelvic Organ Prolapse Quantification. Functional results were obtained subjectively and with quality-of-life questionnaires, including the short-form Incontinence Impact Questionnaire (IIQ) and Urogenital Distress Inventory (UDI), and Female Sexual Function Index.
The mean follow-up period was 5.1 years (range 3.5-7.5 years). Vaginal hysterectomy (37.5%), anterior colporrhaphy (58.3%), posterior colporrhaphy (87.5%), and suburethral slings (31.9%) were performed as indicated. Surgical failure (symptomatic recurrent prolapse of stage 2 or greater in one or more segments) was 11 of 72 (15.3%). Two patients (2.8%) had recurrence of apical prolapse of stage 2 or greater. For those sexually active preoperatively and postoperatively (n=34), mean postoperative Female Sexual Function Index scores for arousal, lubrication, orgasm, satisfaction, and pain were normal, whereas the desire score was abnormal (mean= 3.2). However, 94% (n=29) were currently satisfied with their sexual activity. Postoperative IIQ/UDI scores were significantly improved in all three domains (irritative, P= .01; obstructive, P<.001; stress, P=.03) and overall (IIQ-7, P<.001; UDI, P<.001) compared with preoperatively. Bowel dysfunction occurred 33.3% preoperatively compared with 27.8% postoperatively (P=.24).
Uterosacral ligament vaginal vault fixation seems to be a durable procedure for vaginal repair of enterocele and vaginal vault prolapse. Lower urinary tract, bowel, and sexual function may be maintained or improved.
评估高位子宫骶骨阴道穹窿悬吊术的五年解剖学和功能结局。
确定了1997年1月至2000年1月期间接受治疗的110例有症状的晚期子宫阴道脱垂或子宫切除术后脱垂患者，72例（65%）同意参与本研究。通过盆腔器官脱垂定量法获得解剖学结局。通过主观评估和生活质量问卷获得功能结果，包括简版尿失禁影响问卷（IIQ）、泌尿生殖系统困扰量表（UDI）和女性性功能指数。
平均随访期为5.1年（范围3.5 - 7.5年）。根据需要进行了阴道子宫切除术（37.5%）、前壁修补术（58.3%）、后壁修补术（87.5%）和尿道下吊带术（31.9%）。手术失败（一个或多个节段出现2期或更严重的症状性复发性脱垂）在72例中有11例（15.3%）。2例患者（2.8%）出现2期或更严重的顶端脱垂复发。对于术前和术后有性生活的患者（n = 34），术后性唤起、润滑、性高潮、满意度和疼痛方面的女性性功能指数平均得分正常，而性欲得分异常（平均 = 3.2）。然而，94%（n = 29）目前对其性生活感到满意。与术前相比，术后IIQ/UDI评分在所有三个领域（刺激性，P = .01；梗阻性，P < .001；压力性，P = .03）以及总体（IIQ - 7，P < .001；UDI，P < .001）均有显著改善。术前肠道功能障碍发生率为33.3%，术后为27.8%（P = .24）。
子宫骶骨韧带阴道穹窿固定术似乎是一种用于阴道修复肠膨出和阴道穹窿脱垂的持久手术。下尿路、肠道和性功能可能得以维持或改善。
