Department of Surgical Sciences, "Sapienza" University of Rome, V.le Regina Elena n° 324, 00161 Rome, Italy.
Langenbecks Arch Surg. 2012 Oct;397(7):1157-65. doi: 10.1007/s00423-012-0985-x. Epub 2012 Aug 17.
Pelvic organ prolapse (POP) is a common accompaniment of advancing age. Current repair techniques incorporate transvaginal and transabdominal approaches with or without prosthetic mesh insertion. In this paper, we present the short- and medium-term results of a unit policy directed at patients with POP of combined abdominal rectopexy and Burch retropubic urethropexy without the use of prosthetic mesh assessing its safety profile in selected cases.
Between January 2009 and January 2011, 16 women with tri-compartmental prolapse who had all undergone prior hysterectomy underwent combined surgical pelvic floor repair. Preoperative symptom assessment by validated questionnaires and clinical examination were pre- and postoperatively recorded. Cures were defined as either optimal or satisfactory outcomes based on combined clinical, radiological examinations and reported patient satisfaction.
The mean age of the 16 patients was 57.2 years, and their mean BMI was 28.6 (±5 SD). Pelvic examination revealed a POP-Q stage III prolapse in 12 patients and stage IV in 4 patients. The mean operating time was 57.5 min (range 40-85), with a mean length of hospital stay of 4.5 days. Cystocele and enterocele resolution was noted in every case on dynamic magnetic resonance imaging (MRI).
Our results in a small patient cohort employing a simple 'all-in-one' repair approach combining a retropubic colposuspension with an anterior rectopexy appear to be satisfactory. Further larger randomized studies are required, incorporating a laparoscopic arm in order to determine the longer-term effectiveness of this approach.
盆腔器官脱垂（POP）是随年龄增长而出现的常见并发症。目前的修复技术包括经阴道和经腹入路，可联合或不联合补片置入。本文介绍了我们单位针对 POP 患者的一项治疗策略，即采用腹式直肠固定术和耻骨后膀胱颈悬吊术（Burch）联合治疗，不使用补片，评估其在特定病例中的安全性。
2009 年 1 月至 2011 年 1 月期间，我们对 16 例三间隙脱垂且均已行子宫切除术的女性患者采用联合盆底修复手术。术前通过有效问卷和临床检查进行症状评估，并在术前和术后进行记录。治愈标准为根据联合临床、影像学检查和患者满意度报告确定的最佳或满意结果。
16 例患者的平均年龄为 57.2 岁，平均 BMI 为 28.6（±5 SD）。盆腔检查发现 12 例患者为 POP-Q Ⅲ期脱垂，4 例患者为 POP-Q Ⅳ期脱垂。平均手术时间为 57.5 分钟（范围 40-85 分钟），平均住院时间为 4.5 天。所有患者在动态磁共振成像（MRI）上均显示膀胱膨出和肠膨出完全缓解。
我们在一小部分患者中采用了一种简单的“一站式”修复方法，联合耻骨后膀胱颈悬吊术和经腹直肠固定术，结果似乎令人满意。需要进一步开展更大规模的随机研究，包括腹腔镜手臂，以确定这种方法的长期效果。
