Morley G W, DeLancey J O
University of Michigan Medical Center, Department of Obstetrics and Gynecology, Ann Arbor 48109-0718.
Am J Obstet Gynecol. 1988 Apr;158(4):872-81. doi: 10.1016/0002-9378(88)90088-9.
During the period from January 1, 1974, through June 30, 1987, 100 patients were treated with a sacrospinous ligament suspension of the vaginal apex at the University of Michigan Medical Center. Fifty-seven patients had a posthysterectomy complete vaginal prolapse; 38 patients, an incomplete vaginal prolapse; and five, a posthysterectomy enterocele. Fifty-one patients had had an abdominal hysterectomy and 49 a vaginal hysterectomy previously. Almost half of the patients had had at least one attempt at surgical correction of the prolapse and three patients had had four previous procedures. The immediate postoperative complications were not unexpected. Febrile morbidity responding to appropriate therapy was the most common complication. There was no surgical mortality. Seventy-one of the 78 patients were operated on greater than or equal to 1 year ago and were the subjects of the review. Sixty-four of the patients (90%) had complete symptomatic relief after operation. Ten of these patients had some asymptomatic laxity of the vaginal walls and nine others had satisfactory support but vaginal stenosis or symptoms of stress urinary incontinence after operation. Four patients developed cystoceles and three others had recurrent vaginal prolapse. The vaginal approach to the treatment of eversion of the vagina has many advantages, as reported. The surgical goals described were attained; therefore, use of the sacrospinous ligament fixation procedure as a therapeutic procedure only is defended. The surgical technique is described. Finally, the sacrospinous ligament fixation of vaginal vault prolapse should assume high priority in our therapeutic regimen.
在1974年1月1日至1987年6月30日期间，密歇根大学医学中心对100例患者进行了阴道顶端骶棘韧带悬吊术。57例患者为子宫切除术后完全性阴道脱垂；38例为不完全性阴道脱垂；5例为子宫切除术后肠膨出。51例患者此前接受过腹式子宫切除术，49例接受过阴式子宫切除术。几乎一半的患者至少尝试过一次手术矫正脱垂，3例患者此前接受过4次手术。术后即刻并发症在意料之中。经适当治疗后发热是最常见的并发症。无手术死亡病例。78例患者中有71例手术时间超过或等于1年前，是本次回顾的对象。64例患者（90%）术后症状完全缓解。其中10例患者阴道壁有一些无症状的松弛，另外9例患者支撑效果满意，但术后出现阴道狭窄或压力性尿失禁症状。4例患者出现膀胱膨出，另外3例患者复发阴道脱垂。如报道所述，经阴道途径治疗阴道外翻有许多优点。所描述的手术目标得以实现；因此，仅将骶棘韧带固定术作为一种治疗方法是合理的。本文描述了手术技术。最后，阴道穹窿脱垂的骶棘韧带固定术在我们的治疗方案中应占据重要地位。
