Athanasiou Stavros, Grigoriadis Themos, Chatzipapas Ioannis, Protopapas Athanasios, Antsaklis Aris
First Department of Obstetrics & Gynecology, Urogynecology Unit, University of Athens, 98A Vas. Sofias Avenue, 11528, Athens, Greece.
Int Urogynecol J. 2013 May;24(5):839-45. doi: 10.1007/s00192-012-1947-0. Epub 2012 Oct 18.
We assessed the efficacy and safety of an operative technique, the vaginally assisted laparoscopic sacrocolpopexy (VALS), for the treatment of women with severe uterovaginal prolapse (UVP).
A prospective pilot study of women with severe UVP, who underwent VALS, was carried out. Preoperatively, POP was assessed using the International Continence Society Pelvic Organ Prolapse Quantification (ICS POP-Q) system and symptoms were evaluated using the International Consultation on Incontinence Modular Questionnaire-Vaginal Symptoms (ICIQ-VS). VALS is a combined minimally invasive surgical approach where a vaginal hysterectomy is initially performed, followed by a transvaginal placement of a synthetic mesh which is suspended laparoscopically on the sacral promontory. Postoperative assessment at 12 months was identical to the preoperative assessment with the addition of the Patient Global Impression of Improvement (PGI-I) for urogenital prolapse. Perioperative and postoperative complications were recorded.
Twenty-seven women with a mean age of 57.2 (range, 47-73) were included. Twenty women (74.1%) had stage 3 and 7 (25.9%) had stage 4 POP with a median point C = +5 (range, +2 to +8). VALS was successfully performed in all patients. All patients completed their follow-up assessment at 12 months. All POP-Q points showed statistically significant improvement apart from TVL, which remained unchanged. ICIQ-VS scores showed a statistically significant improvement of the vaginal symptoms and the total quality of life. The sexual matters score showed a tendency towards improvement, although it did not reach statistical significance.
Vaginally assisted laparoscopic sacrocolpopexy appears to be a valid and safe minimally invasive option when treating women presenting with severe UVP, with encouraging short-term anatomical and functional outcomes.
我们评估了一种手术技术——经阴道辅助腹腔镜骶骨阴道固定术（VALS）治疗重度子宫阴道脱垂（UVP）女性患者的疗效和安全性。
对接受VALS手术的重度UVP女性患者进行了一项前瞻性试点研究。术前，使用国际尿控协会盆腔器官脱垂定量（ICS POP-Q）系统评估盆腔器官脱垂情况，并使用国际尿失禁咨询委员会阴道症状模块问卷（ICIQ-VS）评估症状。VALS是一种联合微创外科手术方法，首先进行经阴道子宫切除术，然后经阴道放置合成网片，再通过腹腔镜将其悬吊于骶岬。术后12个月的评估与术前评估相同，增加了针对泌尿生殖系统脱垂的患者总体改善印象（PGI-I）。记录围手术期和术后并发症。
纳入了27名平均年龄为57.2岁（范围47 - 73岁）的女性。20名女性（74.1%）为3期盆腔器官脱垂，7名女性（25.9%）为4期盆腔器官脱垂，中位C点 = +5（范围 +2至 +8）。所有患者均成功完成VALS手术。所有患者均完成了12个月的随访评估。除TVL未改变外，所有POP-Q点均显示出统计学上的显著改善。ICIQ-VS评分显示阴道症状和总体生活质量有统计学上的显著改善。性问题评分虽有改善趋势，但未达到统计学意义。
经阴道辅助腹腔镜骶骨阴道固定术在治疗重度UVP女性患者时似乎是一种有效且安全的微创选择，短期的解剖学和功能学结果令人鼓舞。
