Clinic for Obstetrics and Gynecology, Medical University of Hannover, Carl-Neubergstr. 1, 30625, Hannover, Germany.
Arch Gynecol Obstet. 2012 Dec;286(6):1463-71. doi: 10.1007/s00404-012-2495-z. Epub 2012 Aug 2.
In this study, we sought to confirm the surgical method of vaginal sacrocolporectopexy and previously reported positive perioperative results of this procedure in a large patient group. We describe the approach which offers a vaginal, safe alternative to sacrospinous repair, laparoscopic or open vaginosacropexy and the use of synthetic meshes to treat pelvic organ prolapse.
We conducted a monocentric, prospective, nonrandomized study for treatment of patients with uterine and vaginal vault relapse (grade 2-4). All patients underwent a preoperative urogynecological urodynamic examination. We focus on method, operative time, complications, blood transfusions, hospital stay and clinical data.
Between March 2006 and March 2011, 101 consecutive patients of mean age 64 (40-89) years, with sub or total uterine prolapse (n=69, grade 2-4) and vaginal vault prolapse (n=32, grade 2-4) were treated with vaginal sacrocolporectopexy. Cystocele (grade 2-4) was found in 88 (87.1%) and rectocele (grade 2-4) in 43 (42.5%) patients. Mean duration of surgery with sacrocolporectopexy was 70 min (28-165) without hysterectomy, and 76 min (40-219) with hysterectomy. Regression analysis of all patients (n=101) showed a significant decrease of operative time in the group without hysterectomy after 40 cases. Three bladder lesions, two in patients with a history of hysterectomy, occurred during surgery and were corrected intraoperatively without further complications. No patient required a blood transfusion. Hemoglobin levels decreased slightly from a preoperative mean of 13.6 mg/dl (10.3-15.7) to a postoperative mean of 11.7 mg/dl (8.6-14.7).
Vaginal sacrocolporectopexy is a safe vaginal method for the treatment of sub-/total uterine/vaginal vault prolapse.
本研究旨在通过大宗病例证实阴道骶骨直肠固定术的手术方法，并确认该术式的围手术期结果。我们介绍一种经阴道、安全的替代方法，可替代骶棘固定术、腹腔镜或开放式阴道骶骨固定术以及使用合成网片治疗盆腔器官脱垂。
我们进行了一项单中心、前瞻性、非随机研究，以治疗子宫和阴道穹窿复发（2-4 级）的患者。所有患者均行术前尿生殖妇科尿动力学检查。我们重点关注方法、手术时间、并发症、输血、住院时间和临床数据。
2006 年 3 月至 2011 年 3 月，我们连续治疗了 101 例平均年龄 64 岁（40-89 岁）的患者，其中 69 例患者存在部分或完全子宫脱垂（2-4 级）和阴道穹窿脱垂（2-4 级），32 例患者存在阴道穹窿脱垂（2-4 级）。88 例（87.1%）患者存在膀胱膨出（2-4 级），43 例（42.5%）患者存在直肠膨出（2-4 级）。不切除子宫时，阴道骶骨直肠固定术的平均手术时间为 70 分钟（28-165 分钟），切除子宫时为 76 分钟（40-219 分钟）。对所有 101 例患者（n=101）的回归分析显示，在不切除子宫的 40 例患者中，手术时间显著缩短。手术中有 3 例膀胱损伤，均发生在有子宫切除术史的患者中，术中得到纠正，无进一步并发症。无患者需要输血。血红蛋白水平从术前平均 13.6mg/dl（10.3-15.7）略有下降至术后平均 11.7mg/dl（8.6-14.7）。
阴道骶骨直肠固定术是治疗部分/完全子宫/阴道穹窿脱垂的一种安全的阴道方法。
