Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, Good Samaritan Hospital TriHealth, Cincinnati, OH, USA.
Kaiser Permanente - Dublin Medical Offices & Cancer Center, 3100 Dublin Blvd., Dublin, CA, 94568, USA.
Int Urogynecol J. 2021 Jun;32(6):1519-1525. doi: 10.1007/s00192-020-04571-3. Epub 2020 Oct 22.
To describe the impact of native tissue vaginal reconstruction on pelvic anatomy using dynamic magnetic resonance imaging.
This prospective single-cohort observational study involved women undergoing native tissue reconstruction with intraperitoneal vaginal vault suspension for pelvic organ prolapse. Concomitant procedures such as hysterectomy, midurethral sling, and anterior or posterior colporrhaphy were allowed. Enrolled participants underwent dynamic pelvic imaging pre- and postoperatively. Radiographic and anatomic measurements were compared. Secondary outcomes included validated patient questionnaires.
Fourteen participants were included in the analysis. The mean age was 62 years; all participants were Caucasian. Most participants had stage III pelvic organ prolapse. Significant improvements were noted in several radiographic measurements. The average H-line (representing levator hiatus width) with straining maneuvers improved following surgery (7.2 cm preoperatively vs. 6.6 cm postoperatively, p = 0.015). The average M-line (representing levator muscular descent) improved significantly with both straining (4.0 cm preoperatively vs. 3.0 cm postoperatively, p < 0.001) and defecatory maneuvers (6.2 cm preoperatively vs. 5.2 cm postoperatively, p = 0.001). The average size of cystocele improved from 5.6 cm (moderate) preoperatively to 0.7 cm (absent descent) postoperatively (p < 0.001). The average descent of the vaginal apex with defecation preoperatively was 3.0 cm (moderate) and 0 cm (absent descent) postoperatively (p = 0.003). Posterior compartment descent with defecation did not change following surgical intervention (5.8 cm preoperatively vs. 5.2 cm postoperatively, p = 0.056). Pelvic Organ Prolapse Quantification measurements improved in all compartments, and Pelvic Floor Distress Inventory-20 scores improved significantly following surgery (102 preoperatively vs. 30 postoperatively, p < 0.001).
Native tissue reconstruction with intraperitoneal vaginal vault suspension resulted in significant anatomic improvements, as defined by physical examination and dynamic magnetic resonance imaging.
描述使用动态磁共振成像技术对经阴道自然组织重建术对盆腔解剖结构的影响。
这是一项前瞻性单队列观察性研究，纳入了因盆腔器官脱垂而接受经阴道自然组织重建术（伴或不伴腹腔内阴道穹窿悬吊术）的女性。允许同期进行子宫切除术、中段尿道悬吊带术以及前或后阴道修补术。入组患者在术前和术后均进行了盆腔动态影像学检查。比较影像学和解剖学测量结果。次要结局包括经验证的患者问卷。
14 名患者纳入分析。平均年龄为 62 岁；所有患者均为白种人。大多数患者患有 III 度盆腔器官脱垂。多项影像学测量值均有显著改善。在进行体力活动时，H 线（代表会阴裂孔宽度）的平均值从术前的 7.2cm 改善至术后的 6.6cm（p=0.015）。在进行体力活动和排便动作时，M 线（代表肛提肌下降程度）的平均值从术前的 4.0cm 显著改善至术后的 3.0cm（p<0.001 和 p=0.001）。术前的膀胱膨出大小为 5.6cm（中度），术后改善至 0.7cm（无下降）（p<0.001）。术前排便时阴道顶端下降程度为 3.0cm（中度），术后为 0cm（无下降）（p=0.003）。术后排便时的后盆腔下降程度没有改变（术前 5.8cm 与术后 5.2cm，p=0.056）。所有盆腔器官脱垂定量评估的测量值均得到改善，且盆底窘迫量表-20 评分在术后显著改善（术前 102 分与术后 30 分，p<0.001）。
经阴道自然组织重建术（伴或不伴腹腔内阴道穹窿悬吊术）可导致解剖结构的显著改善，这可通过体格检查和动态磁共振成像来定义。
