Jelovsek J Eric, Maher Christopher, Barber Matthew D
Department of Obstetrics and Gynecology A81, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Lancet. 2007 Mar 24;369(9566):1027-38. doi: 10.1016/S0140-6736(07)60462-0.
Pelvic organ prolapse is downward descent of female pelvic organs, including the bladder, uterus or post-hysterectomy vaginal cuff, and the small or large bowel, resulting in protrusion of the vagina, uterus, or both. Prolapse development is multifactorial, with vaginal child birth, advancing age, and increasing body-mass index as the most consistent risk factors. Vaginal delivery, hysterectomy, chronic straining, normal ageing, and abnormalities of connective tissue or connective-tissue repair predispose some women to disruption, stretching, or dysfunction of the levator ani complex, connective-tissue attachments of the vagina, or both, resulting in prolapse. Patients generally present with several complaints, including bladder, bowel, and pelvic symptoms; however, with the exception of vaginal bulging, none is specific to prolapse. Women with symptoms suggestive of prolapse should undergo a pelvic examination and medical history check. Radiographic assessment is usually unnecessary. Many women with pelvic organ prolapse are asymptomatic and do not need treatment. When prolapse is symptomatic, options include observation, pessary use, and surgery. Surgical strategies for prolapse can be categorised broadly by reconstructive and obliterative techniques. Reconstructive procedures can be done by either an abdominal or vaginal approach. Although no effective prevention strategy for prolapse has been identified, considerations include weight loss, reduction of heavy lifting, treatment of constipation, modification or reduction of obstetric risk factors, and pelvic-floor physical therapy.
盆腔器官脱垂是指女性盆腔器官（包括膀胱、子宫或子宫切除术后的阴道残端，以及小肠或大肠）向下移位，导致阴道、子宫或两者同时突出。脱垂的发生是多因素的，阴道分娩、年龄增长和体重指数增加是最一致的危险因素。阴道分娩、子宫切除术、慢性用力、正常衰老以及结缔组织或结缔组织修复异常使一些女性易发生肛提肌复合体、阴道结缔组织附着处或两者的破坏、拉伸或功能障碍，从而导致脱垂。患者通常有多种主诉，包括膀胱、肠道和盆腔症状；然而，除了阴道膨出外，没有一种症状是脱垂所特有的。有脱垂症状的女性应进行盆腔检查和病史检查。通常不需要进行影像学评估。许多盆腔器官脱垂的女性没有症状，不需要治疗。当脱垂有症状时，治疗选择包括观察、使用子宫托和手术。脱垂的手术策略大致可分为重建性和闭塞性技术。重建手术可通过腹部或阴道途径进行。虽然尚未确定有效的脱垂预防策略，但可考虑的措施包括减肥、减少重物搬运、治疗便秘、改变或降低产科危险因素以及盆底物理治疗。
