Wagenlehner F M E, Bschleipfer T, Liedl B, Gunnemann A, Petros P, Weidner W
Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University Rudolf-Buchheim-Strasse 7 DE-35385 Giessen, Germany.
Urol Int. 2010;84(1):1-9. doi: 10.1159/000273458. Epub 2010 Feb 17.
The human pelvic floor is a complex structure and pelvic floor dysfunction is seen frequently in females.
This review focuses on the surgical reconstruction of the pelvic floor employing recent findings on functional anatomy. A selective literature research was performed by the authors.
Pelvic floor activity is regulated by 3 main muscular forces that are responsible for vaginal tension and suspension of the pelvic floor organs, bladder and rectum. A variety of symptoms can derive from pelvic floor dysfunctions, such as urinary urge and stress incontinence, abnormal bladder emptying, fecal incontinence, obstructive bowel disease syndrome and pelvic pain. These symptoms mainly derive, for different reasons, from laxity in the vagina or its supporting ligaments as a result of altered connective tissue. Pelvic floor reconstruction is nowadays driven by the concept that in case of pelvic floor symptoms, restoration of the anatomy will translate into restoration of the physiology and ultimately improve patients' symptoms.
The surgical reconstruction of the anatomy is almost exclusively focused on the restoration of the lax pelvic floor ligaments. Exact preoperative identification of the anatomical lesions is necessary to allow for exact anatomical reconstruction with respect to the muscular forces of the pelvic floor.
人类盆底是一个复杂的结构，盆底功能障碍在女性中很常见。
本综述聚焦于利用功能解剖学的最新发现进行盆底手术重建。作者进行了选择性文献研究。
盆底活动受3种主要肌肉力量调节，这些力量负责阴道张力以及盆底器官、膀胱和直肠的悬吊。盆底功能障碍可导致多种症状，如尿急和压力性尿失禁、膀胱排空异常、大便失禁、梗阻性肠病综合征和盆腔疼痛。这些症状主要因不同原因，源于结缔组织改变导致的阴道或其支撑韧带松弛。如今，盆底重建的理念是，在出现盆底症状时，解剖结构的恢复将转化为生理功能的恢复，并最终改善患者症状。
解剖结构的手术重建几乎完全专注于松弛的盆底韧带的修复。术前准确识别解剖病变对于根据盆底肌肉力量进行精确的解剖重建是必要的。
