Bui C, Ballester M, Chéreau E, Guillo E, Daraï E
Service de Gynécologie-Obstétrique, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Université Pierre-et-Marie-Curie Paris 6, 4 rue de la Chine, 75020 Paris, France.
Gynecol Obstet Fertil. 2010 Oct;38(10):563-8. doi: 10.1016/j.gyobfe.2010.06.001. Epub 2010 Sep 22.
To evaluate the feasibility and morbidity of laparoscopic promontofixation in the cure of genital prolapse.
From March 2001 to January 2009, 101 patients with genital prolapse of grade greater than or equal to 2 (POPQ classification) were operated by laparoscopy. Complications per and postoperative as well as patient satisfaction were assessed. Quality of life was evaluated using the questionnaires Pelvic Floor Distress Inventory (PFDI 20), Pelvic Floor Impact Questionnaire (PISQ 7) and Pelvic Organ Prolaps/Urinary Incontinence Sexual Questionnaire (PISQ 12).
The mean operative time was 196 min including the time for hysterectomy done in 83% of cases. The peroperative complication rate was 7% including two bladder and one rectal injuries and 4% of laparoconversion. The postoperative complication rate was 16% corresponding to 3/4 of retention of urine. Two pelvic hematomas were observed. The distance complication rate was 3% corresponding to a vaginal erosion, a spondylodiscitis and a case of persistent pelvic pain requiring removal of material. With a mean follow-up of 30.7 months, 81% patients declared themselves satisfied with the intervention. In intention to treat, the satisfaction rate was only 67.3%. A significant improvement in quality of life was observed using the questionnaire PFDI 20 (p < 0.0001), PFIQ 7 (p < 0.0001) et PISQ 12 (p < 0.001).
Our results confirm the feasibility of the laparoscopic promontofixation with a quality of life improvement but also highlights the existence of significant morbidity requiring further trials for the choice of surgical approach for the treatment of genital prolapse.
评估腹腔镜骶骨岬固定术治疗生殖器脱垂的可行性及发病率。
2001年3月至2009年1月，对101例生殖器脱垂程度大于或等于2级（POPQ分类）的患者进行了腹腔镜手术。评估术中及术后并发症以及患者满意度。使用盆底困扰量表（PFDI 20）、盆底影响问卷（PFIQ 7）和盆腔器官脱垂/尿失禁性功能问卷（PISQ 12）对生活质量进行评估。
平均手术时间为196分钟，其中83%的病例包括子宫切除时间。术中并发症发生率为7%，包括2例膀胱损伤、1例直肠损伤以及4%的中转开腹。术后并发症发生率为16%，其中四分之三为尿潴留。观察到2例盆腔血肿。远期并发症发生率为3%，包括1例阴道糜烂、1例脊椎间盘炎以及1例因持续性盆腔疼痛需要取出植入物的病例。平均随访30.7个月，81%的患者表示对干预措施满意。在意向性治疗中，满意度仅为67.3%。使用PFDI 20问卷（p < 0.0001）、PFIQ 7问卷（p < 0.0001）和PISQ 12问卷（p < 0.001）观察到生活质量有显著改善。
我们的结果证实了腹腔镜骶骨岬固定术的可行性以及生活质量的改善，但也凸显了存在显著发病率，需要进一步试验以选择治疗生殖器脱垂的手术方式。
