Moscow State Medical Stomatological University, Urology Department, Russia.
Urogynecology Unit, Department of Obstetrics and Gynecology, Western Galilee Hospital, Nahariya, Israel.
Eur J Obstet Gynecol Reprod Biol. 2014 Jan;172:120-3. doi: 10.1016/j.ejogrb.2013.09.045. Epub 2013 Oct 11.
To evaluate whether anterior-apical compartment mesh implants for pelvic floor reconstruction might be safely and effectively anchored to the sacro-spinous (SS) ligaments instead of the arcus tendineus fascia pelvis (ATFP). The SS ligaments as anchoring structures for centro-apical support mesh fixation are thought to be stronger than the ATFP and we presumed that anterior mesh fixation to the SS ligament might be feasible, safe and effective.
Patients with advanced anterior-apical pelvic floor prolapse, referred for mesh reconstruction and having poor ATFP were enrolled to this study. For these patients the posterior arms of the anterior mesh were fixed to the SS ligaments. Data regarding cure, complications and patient's satisfaction were collected prospectively: patients were interviewed and examined at the end of the first and third post-operative months, and interviewed again at the study conclusion.
Of 72 patients who were asked to participate in this study, 44 had rather un-palpable ATFP, and SS ligament fixation was performed. The mean follow-up duration was 12 months (range: 10-43). No significant intra- or post-operative complications were recorded. The POP-Q points measurements showed marked improvements: the average delta for the Ba point was 7.4cm, for the Bp point 4.7cm, and for the C point 7.9cm. These differences were all statistically significant. Bladder overactivity symptoms, namely urgency, frequency and nocturia, were all found to be reduced significantly, and so was the sexual discomfort rate. Fecal incontinence, pelvic pain and constipation rates were reduced as well, but these did not reach statistical significance.
This rather small study suggests that anterior pelvic floor meshes might be anchored safely and successfully to the SS ligament, aiming to achieve improved centro-apical support of the vaginal apex and the anterior wall by an anterior pelvic floor approach.
评估在盆底重建中使用前-顶壁补片，将其锚定于骶棘（SS）韧带而不是阔韧带（ATFP）是否安全有效。SS 韧带作为中心-顶壁支撑补片固定的锚固结构，其强度被认为高于 ATFP，我们推测将前壁补片固定于 SS 韧带是可行的、安全的和有效的。
本研究纳入了因前-顶壁盆底脱垂而接受补片重建且 ATFP 较差的患者。对于这些患者，前壁补片的后臂固定于 SS 韧带。前瞻性收集了治愈率、并发症和患者满意度的数据：患者在术后第 1 个月和第 3 个月末接受访谈和检查，并在研究结束时再次接受访谈。
在被要求参与本研究的 72 名患者中，有 44 名患者的 ATFP 触诊不明显，因此进行了 SS 韧带固定。平均随访时间为 12 个月（范围：10-43 个月）。未记录到明显的术中或术后并发症。POP-Q 点测量结果显示显著改善：Ba 点的平均差值为 7.4cm，Bp 点为 4.7cm，C 点为 7.9cm。这些差异均具有统计学意义。膀胱过度活动症状，即尿急、尿频和夜尿，均显著减少，性不适率也降低。粪便失禁、盆腔疼痛和便秘率也有所降低，但无统计学意义。
这项规模较小的研究表明，前壁盆底补片可以安全有效地锚定于 SS 韧带，通过前壁盆底入路，实现阴道顶点和前壁的中心-顶壁支撑改善。
