Natale Franca, La Penna Chiara, Padoa Anna, Panei Massimo, Cervigni Mauro
Department of Urogynecology, San Carlo-Istituto Dermopatico dell'Immacolata Sanità, Rome, Italy.
J Urol. 2008 Nov;180(5):2047-52; discussion 2052. doi: 10.1016/j.juro.2008.07.028. Epub 2008 Sep 18.
We evaluated the long-term outcome and complications of high levator myorrhaphy for vaginal apical defects.
A total of 286 patients underwent high levator myorrhaphy. Patients underwent preoperative and postoperative urogynecologic assessment, including evaluation of prolapse stage according to the international pelvic organ prolapse staging system and conventional urodynamic testing. Quality of life was evaluated using the prolapse quality of life questionnaire. We considered failure as vaginal prolapse stage 2 or greater according to the pelvic organ prolapse staging system.
A total of 272 patients with a mean age of 60.4 years were available for analysis. Mean followup was 5 years. In 247 patients we associated tension-free cystocele repair with Marlex mesh. In 50.7% of patients high levator myorrhaphy was done with curative intent, while in the remaining 49.3% it was a preventive measure. Complications included a rectal tear in 2 cases, Marlex mesh erosion in 23 (8.4%), vaginal vault abscess in 1, pararectal hematoma in 2 and buttock pain in 2. Anatomical evaluation at followup revealed a 96.7% cure rate for apical defects and a 26.8% incidence of cystocele. We observed improvement in filling, voiding and post-void symptoms. Quality of life evaluation showed improvement in all domains. We detected a 9.6% incidence of de novo dyspareunia.
High levator myorrhaphy is a safe and effective procedure for preventing and curing vaginal apical defects. The simplicity of this surgical procedure, its short learning curve, the lack of severe complications and its low costs combined with symptomatic relief and improvement in quality of life encourage its use for the cure and routine prevention of vaginal apical prolapse.
我们评估了高位提肌缝合术治疗阴道顶端缺损的长期疗效及并发症。
共有286例患者接受了高位提肌缝合术。患者在术前和术后接受了泌尿妇科评估，包括根据国际盆腔器官脱垂分期系统评估脱垂程度以及常规尿动力学检查。使用脱垂生活质量问卷评估生活质量。根据盆腔器官脱垂分期系统，我们将阴道脱垂2期或更严重视为手术失败。
共有272例平均年龄为60.4岁的患者可供分析。平均随访时间为5年。在247例患者中，我们将无张力膀胱阴道修补术与Marlex网片联合使用。50.7%的患者进行高位提肌缝合术是为了治愈疾病，而其余49.3%的患者则是作为一种预防措施。并发症包括2例直肠撕裂、23例（8.4%）Marlex网片侵蚀、1例阴道穹窿脓肿、2例直肠旁血肿和2例臀部疼痛。随访时的解剖学评估显示顶端缺损的治愈率为96.7%，膀胱膨出的发生率为26.8%。我们观察到充盈、排尿及排尿后症状均有改善。生活质量评估显示所有领域均有改善。我们检测到新发性交困难的发生率为9.6%。
高位提肌缝合术是预防和治疗阴道顶端缺损的一种安全有效的手术方法。该手术操作简单，学习曲线短，缺乏严重并发症，成本低，同时能缓解症状并改善生活质量，因此鼓励将其用于治疗和常规预防阴道顶端脱垂。
