Yassa Murat, Tug Niyazi
Department of Obstetrics and Gynecology, Health Sciences University, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul, Turkey.
Geburtshilfe Frauenheilkd. 2019 Sep;79(9):983-992. doi: 10.1055/a-0941-3485. Epub 2019 Aug 5.
Laparoscopic lateral suspension with mesh (LLSM) is an effective and less invasive technique for the correction of pelvic organ prolapse. We discuss the primary objectives, subjective success rate and pelvic floor ultrasound outcomes of uterus-preserving LLSM operations. Seventeen patients who underwent uterus-preserving LLSM (abdominocervicopexy) in a tertiary center were included in this prospective study. Anatomical cure was defined separately for the apical and anterior compartments as a Pelvic Organ Prolapse Quantification (POP-Q) score of less than - 1 cm for each compartment. Subjective cure was defined as the absence of bulge symptoms. Patient satisfaction, sexual function, prolapse-related quality of life, voiding dysfunction, nocturia and constipation were assessed. Transperineal ultrasonography was used to measure anterior compartment mobility and hiatal anteroposterior diameter. The anatomical cure rate was 100% for the apical and 88.2% for the anterior compartment, with one symptomatic stage-II cystorectocele and one asymptomatic stage-II cystocele. The subjective cure and patient satisfaction scores were 94.12 and 100%, respectively. Ba and C points were significantly improved, and vaginal lengthening was 10.14 ± 4.19 mm. Bp ascent was 5.72 ± 11.27 mm (p = 0.053). Proximal urethral rotation and retrovesical angles were reduced by 6.24 ± 11.95° and 27 ± 47.2°, respectively (p1 = 0.047; p2 = 0.032). The hiatal anteroposterior diameter was shortened by 4.36% (p = 0.039). A significant improvement was seen with regard to nocturia episodes but not for constipation. No mesh exposure was observed. Uterus-preserving LLSM (abdominocervicopexy) was found to be effective for the correction of apical and anterior prolapse with high levels of patient satisfaction. Significant improvements in urge symptoms and frequency of nocturia were observed. Pelvic floor ultrasound outcomes may be useful when comparing this procedure with other surgical techniques.
腹腔镜网片侧方悬吊术（LLSM）是一种用于纠正盆腔器官脱垂的有效且侵入性较小的技术。我们讨论了保留子宫的LLSM手术的主要目标、主观成功率和盆底超声检查结果。本前瞻性研究纳入了在一家三级中心接受保留子宫的LLSM（腹宫颈固定术）的17例患者。分别将盆腔器官脱垂定量（POP-Q）评分每个腔隙小于 -1 cm定义为顶端和前盆腔腔隙的解剖学治愈。主观治愈定义为无膨出症状。评估了患者满意度、性功能、脱垂相关生活质量、排尿功能障碍、夜尿症和便秘情况。采用经会阴超声测量前盆腔腔隙活动度和裂孔前后径。顶端解剖学治愈率为100%，前盆腔腔隙为88.2%，有1例有症状的Ⅱ度膀胱膨出和1例无症状的Ⅱ度膀胱膨出。主观治愈率和患者满意度评分分别为94.12%和100%。Ba点和C点有显著改善，阴道延长10.14±4.19 mm。Bp上升5.72±11.27 mm（p = 0.053）。近端尿道旋转和膀胱后角分别减少6.24±11.95°和27±47.2°（p1 = 0.047；p2 = 0.032）。裂孔前后径缩短4.36%（p = 0.039）。夜尿症发作有显著改善，但便秘情况无改善。未观察到网片暴露。发现保留子宫的LLSM（腹宫颈固定术）对于纠正顶端和前盆腔脱垂有效，患者满意度高。观察到尿急症状和夜尿症频率有显著改善。在将该手术与其他手术技术进行比较时，盆底超声检查结果可能会有帮助。
