University of New South Wales, Sydney, New South Wales, Australia.
St Vincent's Hospital, Darlinghurst, New South Wales, Australia.
Neurourol Urodyn. 2018 Nov;37(8):2740-2744. doi: 10.1002/nau.23737. Epub 2018 Jul 4.
Limited data exist associating vaginal vault and introital defects before and after posterior repairs (PR). We hypothesize: (i) a positive association between the size of vaginal vault and introital defects preoperatively; and (ii) a positive association between the reduction of these defects postoperatively if vault fixation (sacrospinous colpopexy-SSC) is used with the PR.
In a cross-sectional study of 300 consecutive PRs, the following were measured pre- and immediately postoperatively: (i) from POP-Q: genital hiatus (GH-Level III); (ii) from PR-Q: perineal gap (PG-Level III), posterior vaginal vault descent (PVVD-Level I). The data for introital defects (GH, PG) were separated according to the need for vault fixation using a SSC due to a larger vaginal defect (PVVD over 5 cm).
Mean (SD) preoperative GH and PG were both significantly larger in the SSC versus no SSC group: GH (3.73 [0.94] vs 3.36 [0.83] cm, P = 0.01); PG (2.91 [1.0] vs 2.61 [0.91] cm, P = 0.05). SSC performed with the PR (84%); not performed (16%) cases. The mean (SD) postoperative reduction in GH (antero-posterior) was significantly (29%-P = 0.002) greater-1.1 (0.69) cm (29.5%) in the SSC group and 0.77 (0.49) cm (22.9%) in the no SSC group. The decrease in the PG (transverse) was greater by 11% (0.05).
Levels I and III defects are associated with PRs; preoperatively larger vaginal vault (PVVD over 5 cm) and larger introital defects (GH, PG). Postoperatively, vault fixation resulted in significantly greater reduction in the introital defects.
Vaginal vault fixation (SSC) significantly improves the vaginal introital repair.
目前关于阴道穹窿和阴道入口缺陷与后路修补术（PR）前后的关联，数据十分有限。我们假设：（i）阴道穹窿的大小与术前阴道入口缺陷呈正相关；（ii）如果使用阴道穹窿固定（骶骨阴道固定术-SSC）与 PR 联合应用，这些缺陷的术后改善与阴道穹窿的缩小呈正相关。
在一项对 300 例连续 PR 患者的横断面研究中，我们在术前和术后即刻测量了以下指标：（i）POP-Q 系统：会阴体高度（GH-III 级）；（ii）PR-Q 系统：会阴裂伤（PG-III 级），阴道后穹窿下降（PVVD-I 级）。根据阴道穹窿缺陷的大小（PVVD 大于 5cm），我们将用于阴道穹窿固定（由于阴道穹窿较大而需要 SSC）的 introital 缺陷（GH、PG）数据进行了分组。
SSC 组的术前 GH 和 PG 均明显大于无 SSC 组：GH（3.73[0.94] vs 3.36[0.83]cm，P=0.01）；PG（2.91[1.0] vs 2.61[0.91]cm，P=0.05）。PR 联合 SSC 组（84%）和未行 SSC 组（16%）分别进行了 SSC 手术。SSC 组 GH（前后向）的术后平均（SD）减少量显著更大-1.1（0.69）cm（29%-P=0.002），而无 SSC 组为 0.77（0.49）cm（22.9%）。PG（横向）的减少量增加了 11%（0.05）。
I 级和 III 级缺陷与 PR 相关；术前阴道穹窿较大（PVVD 大于 5cm）和 introital 缺陷较大（GH、PG）。术后，阴道穹窿固定术显著改善了 introital 缺陷。
阴道穹窿固定术（SSC）可显著改善阴道入口的修复效果。
