Wagner L, Macia F, Delmas V, Haab F, Costa P
Service d'Urologie, Hôpital Carémeau, CHU de Nîmes, Université Montpellier-I, Place du Pr-R-Debré, 30029 Nîmes cedex 9, France.
Prog Urol. 2009 Dec;19(13):988-93. doi: 10.1016/j.purol.2009.09.024. Epub 2009 Oct 21.
Abdominal sacrofixation is the gold standard for the treatment of the prolapse. There are many ways to do it: technical, meshes, dissection, fixation of the mesh, associated procedures. Laparotomy is the classical procedure for sacrofixation. The basis of sacrofixation is to dissect the weak vesicovaginal and rectovaginal fascias and to replace with meshes spread out on the entire dissected surface.
Suprapubic abdominal incision, dissection of the anterior vertebral ligament on the right of the promontory, dissection of the vesicovaginal and rectovaginal spaces; meshes are fixed anteriorly on the vagina, posteriorly on the levator ani and uterosacral ligaments. The peritoneum on the meshes is carefully closed to avoid later ileus.
Redux is globally 10% (74-98%); the redux occur in the two years. Meshes exposure, spondilodiscitis, ileus are uncommon. In comparison with the vaginal procedures, there is less redux, less dyspareunia. But the drawbacks are postoperative pains, scars, eventration, low dissection difficult and some contraindications to the abdominal sacrofixation: respiratory insufficiency, morbid obesity, multi-operated abdomen, ascitis, aortoiliac aneurysms.
腹骶固定术是治疗子宫脱垂的金标准。其实施方式有多种：技术层面、补片、解剖、补片固定、相关手术步骤。剖腹手术是骶骨固定术的经典术式。骶骨固定术的基础是解剖薄弱的膀胱阴道筋膜和直肠阴道筋膜，并用铺展在整个解剖表面的补片进行替代。
耻骨上腹部切口，解剖岬右侧的前椎韧带，解剖膀胱阴道间隙和直肠阴道间隙；补片前部固定于阴道，后部固定于肛提肌和子宫骶韧带。仔细缝合补片上的腹膜以避免日后发生肠梗阻。
总体复发率为10%（74 - 98%）；复发发生在两年内。补片外露、脊椎椎间盘炎、肠梗阻并不常见。与经阴道手术相比，复发较少，性交困难也较少。但缺点是术后疼痛、瘢痕、腹壁疝、低位解剖困难以及腹骶固定术存在一些禁忌证：呼吸功能不全、病态肥胖、多次腹部手术史、腹水、腹主动脉瘤。
