Department of Obstetrics & Gynaecology, John Radcliffe Hospital, Oxford, UK.
BJOG. 2010 Jan;117(1):62-8. doi: 10.1111/j.1471-0528.2009.02396.x.
The aim of this study was to evaluate the outcome of laparoscopic hysteropexy, a surgical technique for the management of uterine prolapse, involving suspension of the uterus from the sacral promontory using bifurcated polypropylene mesh.
The investigation was designed as a prospective observational study (clinical audit).
The study was undertaken at a tertiary referral urogynaecology unit in the UK.
The participants comprised 51 consecutive women with uterovaginal prolapse, who chose laparoscopic hysteropexy as one of the available surgical options.
The hysteropexy was conducted laparoscopically in all cases. A bifurcated polypropylene mesh was used to suspend the uterus from the sacral promontory. The two arms of the mesh were introduced through bilateral windows created in the broad ligaments, and were sutured to the anterior cervix; the mesh was then fixed to the anterior longitudinal ligament over the sacral promontory, to elevate the uterus.
Cure of the uterine prolapse was evaluated subjectively using the International Consultation on Incontinence Questionnaire for vaginal symptoms (ICIQ-VS), and objectively by vaginal examination using the Baden-Walker halfway system and the pelvic organ prolapse quantification (POP-Q) scale. Operative and postoperative complications were also assessed.
The mean age of the 51 women was 52.5 years (range 19-71 years). All were sexually active, and at least three of them expressed a strong desire to have children in the future. All were available for follow-up in clinic at 10 weeks, and 38 have completed the questionnaires. In 50 out of 51 women the procedure was successful, with no objective evidence of uterine prolapse on examination at follow-up; there was one failure. Significant subjective improvements in prolapse symptoms, sexual wellbeing and related quality of life were observed, as detected by substantial reductions in the respective questionnaire scores.
Laparoscopic hysteropexy is both a feasible and an effective procedure for correcting uterine prolapse without recourse to hysterectomy. It allows restoration of the length of the vagina without compromising its calibre, and is therefore likely to have a favourable functional outcome.
本研究旨在评估腹腔镜子宫固定术（一种治疗子宫脱垂的手术技术）的治疗效果。该手术采用分叉聚丙烯网片将子宫从骶骨岬骨悬吊固定。
本研究为前瞻性观察性研究（临床审计）。
本研究在英国一家三级转诊妇科泌尿科进行。
51 例连续患有子宫阴道脱垂的女性参与了本研究，这些患者选择腹腔镜子宫固定术作为可选择的手术方案之一。
所有病例均采用腹腔镜进行子宫固定术。分叉聚丙烯网片用于将子宫从骶骨岬骨悬吊固定。网片的两个分支通过在阔韧带中创建的双侧窗口引入，并缝合到子宫颈前壁；然后，网片固定在骶骨岬骨上方的前纵韧带，以提升子宫。
采用阴道症状国际咨询尿失禁问卷（ICIQ-VS）对子宫脱垂的治疗效果进行主观评估，采用 Baden-Walker 半程系统和盆腔器官脱垂定量（POP-Q）量表进行阴道检查进行客观评估。还评估了手术和术后并发症。
51 名女性的平均年龄为 52.5 岁（19-71 岁）。所有女性均有性生活，至少有 3 名女性表示未来强烈希望生育孩子。所有女性均在术后 10 周接受了门诊随访，其中 38 名完成了问卷调查。在 51 名女性中，有 50 名手术成功，随访时检查未发现子宫脱垂的客观证据；有 1 例失败。问卷调查评分显著降低，表明患者的脱垂症状、性生活和相关生活质量均有显著改善。
腹腔镜子宫固定术是一种可行且有效的治疗子宫脱垂的方法，无需进行子宫切除术。该手术可以恢复阴道的长度而不影响其口径，因此可能具有良好的功能效果。
