Matthews Catherine A
Department of Urology and Obstetrics and Gynecology, Wake Forest University Medical Center, Watlington Hall, 5th Floor, 1 Medical Center Boulevard, Winston Salem, NC, 27517, USA.
Curr Urol Rep. 2016 Nov;17(11):81. doi: 10.1007/s11934-016-0638-7.
Sacrocolpopexy remains the "gold standard" procedure for management of posthysterectomy vaginal vault prolapse with improved anatomic outcomes compared to native tissue vaginal repair. Despite absence of clinical data, sacrocolpopexy is increasingly being offered to women as a primary treatment intervention for uterine prolapse. While reoperation rates remain low, recurrent prolapse and vaginal mesh exposure appear to increase over time. The potential morbidity associated with sacrocolpopexy is higher than for native tissue vaginal repair with complications including sacral hemorrhage, discitis, small bowel obstruction, port site herniation, and mesh erosion. Complications are more common during the learning curve of minimally invasive sacrocolpopexy. Appropriate case selection is paramount to balancing the potential for prolapse recurrence with the risk of surgical complications. Use of ultra-lightweight polypropylene mesh and vaginal mesh attachment with delayed absorbable suture may reduce the risks of vaginal mesh exposure.
骶骨阴道固定术仍然是子宫切除术后阴道穹窿脱垂治疗的“金标准”手术，与自体组织阴道修复相比，其解剖学效果更佳。尽管缺乏临床数据，但骶骨阴道固定术越来越多地作为子宫脱垂的主要治疗手段提供给女性患者。虽然再次手术率仍然较低，但随着时间的推移，复发脱垂和阴道网片暴露似乎有所增加。与骶骨阴道固定术相关的潜在发病率高于自体组织阴道修复，并发症包括骶骨出血、椎间盘炎、小肠梗阻、穿刺部位疝和网片侵蚀。在微创骶骨阴道固定术的学习曲线阶段，并发症更为常见。合适的病例选择对于平衡脱垂复发风险和手术并发症风险至关重要。使用超轻聚丙烯网片以及用延迟可吸收缝线进行阴道网片固定可能会降低阴道网片暴露的风险。
