Schiavi Michele Carlo, DʼOria Ottavia, Faiano Pierangelo, Prata Giovanni, Di Pinto Anna, Sciuga Valentina, Colagiovanni Vanessa, Giannini Andrea, Zullo Marzio Angelo, Monti Marco, Muzii Ludovico, Benedetti Panici Pierluigi
Department of Surgery-Week Surgery, Campus Biomedico, University of Rome, Rome, Italy.
Female Pelvic Med Reconstr Surg. 2018 Nov/Dec;24(6):419-423. doi: 10.1097/SPV.0000000000000463.
The aim of this study was to assess the effectiveness and safety of vaginal native tissue repair for symptomatic rectocele and to evaluate the impact on quality of life (QoL) and sexual function.
One hundred fifty-one patients affected by rectocele stage II or higher according to the Pelvic Organ Prolapse Quantification System were enrolled. Patients underwent vaginal native tissue repair. Postoperative assessments consisted in a clinical examination and assessment of posterior compartment symptoms and defecatory dysfunctions. These were conducted 1, 12, and 60 months after surgery. Patients completed the Prolapse Quality-of-Life questionnaire, the Pelvic Floor Disability Index, the Pelvic Floor Impact Questionnaire, and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form.
The median follow-up was 64 (60-72) months. The median operative time was 55 (37-127) minutes, and the median postoperative hospital stay was 2 (2-4) days. No intraoperative complications occurred. At median follow-up, an objective cure rate of 88.2% was observed. Seventeen patients (11.3%) showed recurrent posterior vaginal descent stage II or higher. Defecatory dysfunctions, vaginal digitation, and vaginal bulge decreased significantly. The change of values of the Prolapse Quality-of-Life, Pelvic Floor Disability Index, and Pelvic Floor Impact Questionnaire questionnaires has shown a significant improvement in the QoL after surgery. The percentage of patients regularly practicing sexual activity increased, and dyspareunia decreased after treatment.
Vaginal native tissue repair is a safe and effective procedure for symptomatic rectocele, with a low rate of complications, and improves pelvic organ prolapse-related symptoms, QoL, and sexual function.
本研究旨在评估阴道原生组织修复治疗有症状直肠膨出的有效性和安全性，并评估其对生活质量（QoL）和性功能的影响。
纳入151例根据盆腔器官脱垂量化系统诊断为II期或更高分期直肠膨出的患者。患者接受阴道原生组织修复。术后评估包括临床检查以及对后盆腔症状和排便功能障碍的评估。这些评估在术后1个月、12个月和60个月进行。患者完成脱垂生活质量问卷、盆底功能障碍指数、盆底影响问卷和盆腔器官脱垂/尿失禁性功能问卷简表。
中位随访时间为64（60 - 72）个月。中位手术时间为55（37 - 127）分钟，中位术后住院时间为2（2 - 4）天。未发生术中并发症。中位随访时，客观治愈率为88.2%。17例患者（11.3%）出现II期或更高分期的复发性阴道后壁脱垂。排便功能障碍、阴道指诊和阴道膨出明显减少。脱垂生活质量、盆底功能障碍指数和盆底影响问卷的分值变化显示术后生活质量有显著改善。定期进行性活动的患者比例增加，治疗后性交困难减少。
阴道原生组织修复是治疗有症状直肠膨出的一种安全有效的方法，并发症发生率低，可改善盆腔器官脱垂相关症状、生活质量和性功能。
