Department of Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, PR China.
Department of Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, PR China.
Int J Surg. 2018 Apr;52:40-43. doi: 10.1016/j.ijsu.2018.02.021. Epub 2018 Feb 16.
Pelvic organ prolapse (POP) is a common disease in women. The aim of this research was to evaluate the safety, efficacy and complication of transvaginal modified sacrospinous ligament fixation with mesh using for the treatment of vaginal vault prolapse.
This was a prospective study including information from 60 symptomatic women with anterior-apical pelvic floor prolapse. The patients underwent transvaginal modified sacrospinous ligament fixation combined with anterior vaginal wall mesh between May 2014 and Sep 2015. The perioperative data including clinical characteristic, operation time, blood loss, and surgical complications were collected at 1 year and 2 years. During a 2-year follow-up, the primary outcome evaluation included Pelvic organ prolapse Quantification system (POP-Q), Incontinence Quality of Life scale (I-QoL), the Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and the Pelvic Floor Distress Inventory, short form 20 (PFDI-20).
The mean follow-up time was 2 years (range 24-37 months). The patients' mean age was 66.75 ± 6.44. Of 60 patients who were enrolled in this research, 26 patients had severe stress urinary incontinence (SUI). The mean operation time was 99.14 ± 19.60 min and the mean estimated blood loss was 73.83 ± 41.05 ml. The rate of anatomical success was 98.3% and one patient had a recurrence. The POP-Q point measurements were evaluated preoperatively and postoperatively (P < 0.001). Moreover, the quality of life and sexual activity were all improved postoperatively via I-QoL, PISQ-12 and PFDI-20 scores (P < 0.001). There was no injury to the rectum, bladder, major pelvic vessels and pudendal nerves. However, 18 patients had postoperative complications.
This study showed that transvaginal modified sacrospinous ligament fixation with mesh might be performed easily and might be a safe surgery for elderly patients whose requirements for sexual life were relatively low. Further researches were required to investigate its long-term efficacy.
盆腔器官脱垂（POP）是女性的常见疾病。本研究旨在评估经阴道改良骶棘韧带固定术联合网片治疗阴道穹窿脱垂的安全性、疗效和并发症。
这是一项前瞻性研究，纳入了 2014 年 5 月至 2015 年 9 月期间 60 例有前-中盆腔器官脱垂症状的女性患者的信息。患者接受经阴道改良骶棘韧带固定术联合前阴道壁网片治疗。收集围手术期数据，包括临床特征、手术时间、出血量和手术并发症，并在术后 1 年和 2 年进行评估。在 2 年的随访期间，主要结局评估包括盆腔器官脱垂量化系统（POP-Q）、尿失禁生活质量量表（I-QoL）、尿失禁/性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）。结果：平均随访时间为 2 年（范围 24-37 个月）。患者平均年龄为 66.75±6.44 岁。60 例患者中，26 例合并严重压力性尿失禁（SUI）。平均手术时间为 99.14±19.60min，平均估计出血量为 73.83±41.05ml。解剖成功率为 98.3%，1 例复发。POP-Q 点测量值术前和术后比较（P<0.001）。此外，通过 I-QoL、PISQ-12 和 PFDI-20 评分，术后生活质量和性功能均有改善（P<0.001）。未损伤直肠、膀胱、主要盆腔血管和阴部神经。然而，18 例患者术后出现并发症。
本研究表明，经阴道改良骶棘韧带固定术联合网片治疗老年患者阴道穹窿脱垂可能较为容易，且对性生活要求相对较低的老年患者较为安全。需要进一步研究来探讨其长期疗效。
