Department of Gynaecology, University of New South Wales, Sydney, New South Wales, Australia.
Department of Anatomy, University of Notre Dame, Sydney, New South Wales, Australia.
Neurourol Urodyn. 2022 Aug;41(6):1316-1322. doi: 10.1002/nau.24963. Epub 2022 May 27.
Vaginal vault (VV) surgery should be a key part of surgery for a majority of pelvic organ prolapse (POP). The surgical anatomy of the VV, the upper most part of the vagina, has not been recently subject to a dedicated examination and description.
Cadaver studies were performed in (i) 10 unembalmed cadaveric pelves (observation); (ii) 2 unembalmed cadaveric pelves (dissection); (iii) 5 formalinized hemipelves (dissection). The structural outline and ligamentous supports of the VV were determined. Further confirmation of observations in post-hysterectomy patients were from a separate study on 300 consecutive POP repairs, 46% of whom had undergone prior hysterectomy.
The VV is equivalent to the Level I section of the vagina, measured posteriorly from the top of the posterior vaginal wall (apex or highest part of the vagina) to 2.5 cm below this point. It comprises the anterior fornix (through which cervix protrudes or is removed at hysterectomy), posterior fornix and two lateral fornices. Before hysterectomy, the posterior aspects of the cervix and upper vagina are supported by the uterosacral (USL) and cardinal ligaments (CL), the distal segments of which fuse together to form a cardinal-uterosacral ligament complex (cardinal utero-sacral complex), around 2-3 cm long. Post---hysterectomy, there is some residual USL support to the anterior fornix but the posterior fornix has no ligamentous support and is thus more vulnerable to prolapse.
Effective management of VV prolapse will need to be part of most POP repairs. Enhanced understanding of the surgical anatomy of the vaginal vault allows more effective planning of those POP surgeries.
阴道穹窿（VV）手术应该是大多数盆腔器官脱垂（POP）手术的关键部分。阴道穹窿是阴道的最上部，其手术解剖结构最近没有经过专门的检查和描述。
在（i）10 具未防腐的尸体骨盆（观察）；（ii）2 具未防腐的尸体骨盆（解剖）；（iii）5 具福尔马林化的半骨盆（解剖）中进行尸体研究。确定了 VV 的结构轮廓和韧带支撑。在接受过子宫切除术的患者中进一步证实了观察结果，来自 300 例连续 POP 修复的单独研究，其中 46%的患者接受过子宫切除术。
VV 相当于阴道的 I 级部分，从前阴道后壁的顶部（后穹窿顶点或阴道最高点）向后测量 2.5 厘米。它包括前阴道穹窿（宫颈突出或在子宫切除术中被切除的地方）、后阴道穹窿和两个侧阴道穹窿。在子宫切除术前，宫颈和阴道上部的后侧面由子宫骶骨（USL）和主韧带（CL）支撑，其远端段融合在一起形成一个主-子宫骶骨韧带复合体（主-子宫骶骨复合体），长约 2-3 厘米。子宫切除术后，前阴道穹窿仍有一些残余的 USL 支撑，但后阴道穹窿没有韧带支撑，因此更容易脱垂。
大多数 POP 修复术都需要对 VV 脱垂进行有效治疗。增强对阴道穹窿手术解剖结构的理解，可以更有效地规划那些 POP 手术。
