Kakinuma Toshiyuki, Kaneko Ayaka, Kakinuma Kaoru, Imai Ken, Takeshima Nobuhiro, Ohwada Michitaka
Department of Obstetrics and Gynecology, International University of Health and Welfare, Nasushiobara 329-2763, Japan.
World J Clin Cases. 2023 May 26;11(15):3457-3463. doi: 10.12998/wjcc.v11.i15.3457.
Laparoscopic sacrocolpopexy for pelvic organ prolapse (POP) is a new and widely used approach; however, ever since the United States Food and Drug Administration warned against the use of surgical mesh, repairs performed using patients' tissues [ native tissue repair (NTR)] instead of mesh have attracted much attention. At our hospital, laparoscopic sacrocolpopexy (the Shull method) was introduced in 2017. However, patients with more severe POP who have a long vaginal canal and overextended uterosacral ligaments may not be candidates for this procedure.
To validate a new NTR treatment for POP, we examined patients undergoing laparoscopic vaginal stump-round ligament fixation (the Kakinuma method).
The study patients were 30 individuals with POP who underwent surgery using the Kakinuma method between January 2020 and December 2021 and who were followed up for > 12 mo after surgery. We retrospectively examined surgical outcomes for surgery duration, blood loss, intraoperative complications, and incidence of recurrence. The Kakinuma method involves round ligament suturing and fixation on both sides, effectively lifting the vaginal stump after laparoscopic hysterectomy.
The patients' mean age was 66.5 ± 9.1 (45-82) years, gravidity was 3.1 ± 1.4 (2-7), parity was 2.5 ± 0.6 (2-4) times, and body mass index was 24.5 ± 3.3 (20.9-32.8) kg/m. According to the POP quantification stage classification, there were 8 patients with stage II, 11 with stage III, and 11 with stage IV. The mean surgery duration was 113.4 ± 22.6 (88-148) min, and the mean blood loss was 26.5 ± 39.7 (10-150) mL. There were no perioperative complications. None of the patients exhibited reduced activities of daily living or cognitive impairment after hospital discharge. No cases of POP recurrence were observed 12 mo after the operation.
The Kakinuma method, similar to conventional NTR, may be an effective treatment for POP.
腹腔镜骶骨阴道固定术治疗盆腔器官脱垂（POP）是一种新的且广泛应用的方法；然而，自从美国食品药品监督管理局对手术网片的使用发出警告后，使用患者自身组织进行的修复术[自体组织修复（NTR）]而非网片受到了广泛关注。我院于2017年引入了腹腔镜骶骨阴道固定术（舒尔法）。然而，对于阴道管较长且子宫骶韧带过度伸展的重度POP患者，可能不适合该手术。
为验证一种新的NTR治疗POP的方法，我们对接受腹腔镜阴道残端-圆韧带固定术（柿沼法）的患者进行了研究。
研究对象为30例POP患者，于2020年1月至2021年12月期间接受了柿沼法手术，并在术后进行了超过12个月的随访。我们回顾性分析了手术持续时间、出血量、术中并发症及复发率等手术结果。柿沼法包括双侧圆韧带缝合与固定，在腹腔镜子宫切除术后可有效提升阴道残端。
患者的平均年龄为66.5±9.1（45 - 82）岁，孕次为3.1±1.4（2 - 7）次，产次为2.5±0.6（2 - 4）次，体重指数为24.5±3.3（20.9 - 32.8）kg/m²。根据POP量化分期分类，Ⅱ期患者8例，Ⅲ期患者11例，Ⅳ期患者11例。平均手术持续时间为113.4±22.6（88 - 148）分钟，平均出血量为26.5±39.7（10 - 150）毫升。围手术期无并发症发生。出院后患者日常生活活动能力均未下降，也无认知功能障碍。术后12个月未观察到POP复发病例。
与传统NTR类似，柿沼法可能是治疗POP的一种有效方法。
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