Aichner Simone, Studer Andreas, Frey Janine, Brambs Christine, Krebs Jörg, Christmann-Schmid Corina
Department of Urogynecology, Women's Hospital, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne, Switzerland.
Swiss Paraplegic Research, Guido A. Zäch Strasse 4, 6207 Nottwil, Switzerland.
J Clin Med. 2024 Aug 26;13(17):5051. doi: 10.3390/jcm13175051.
: Laparoscopic sacrocolpopexy is regarded as the gold standard treatment for apical or multicompartment prolapse, predominantly with anterior compartment descent. However, the optimal surgical approach for concurrent rectocele is still debated. The aim of this study was to evaluate the effectiveness of nerve-sparing laparoscopic sacrocolpopexy in managing multicompartment prolapse with concurrent rectocele (≥stage II), analyzing the anatomical outcomes, the necessity for concomitant or subsequent posterior repair, and the impact on bowel function in women undergoing surgery. : Data from all women who underwent laparoscopic sacrocolpopexy with or without posterior repair between 01/2017 and 07/2022 for symptomatic multicompartment prolapse, including apical and posterior compartment descent ≥ stage II, were retrospectively evaluated. All women underwent a standardized urogynecological examination, including assessment of genital prolapse using the POP-Q quantification system, and completed the German-validated Australian Pelvic Floor Questionnaire before and after surgery (6-12 weeks). Preoperative anatomic support and bowel symptoms were compared with postoperative values. : In total, 112 women met the criteria for surgical correction. The majority (87%) had stage II posterior descent, with only 10% undergoing concurrent posterior repair during laparoscopic sacrocolpopexy. Significant ( < 0.001) objective improvement was seen for all compartments post- compared with preoperatively (Ba: 0 (-1/2) vs. -3 (-3/-2), C: -1 (-2/0) vs. -8 (-12/-7), Bp: 0 (-1/0) vs. -3 (-2/-2); (median (25%/75% quartiles)). Subsequent surgery for persistent rectocele and/or stool outlet symptoms was required in 4% of cases. Most bowel-specific questions in the German-validated Australian Pelvic Floor Questionnaire showed significant improvement ( < 0.001). : Nerve-sparing sacrocolpopexy alone appears to be a suitable surgical approach to correct multicompartment prolapse, including a rectocele ≥ stage II, and results in a reduction of objective signs and symptoms of pelvic organ prolapse.
腹腔镜骶骨阴道固定术被视为治疗顶端或多部位脱垂（主要伴有前盆腔脏器脱垂）的金标准治疗方法。然而，对于同时存在直肠膨出的最佳手术方式仍存在争议。本研究的目的是评估保留神经的腹腔镜骶骨阴道固定术治疗伴有直肠膨出（≥Ⅱ期）的多部位脱垂的有效性，分析解剖学结果、同期或后续进行后盆腔修复的必要性以及对接受手术女性肠道功能的影响。
回顾性评估了2017年1月至2022年7月期间因有症状的多部位脱垂（包括顶端和后盆腔脏器脱垂≥Ⅱ期）接受或未接受后盆腔修复的腹腔镜骶骨阴道固定术的所有女性的数据。所有女性均接受了标准化的泌尿妇科检查，包括使用盆腔器官脱垂定量（POP-Q）系统评估生殖器脱垂，并在手术前后（6 - 12周）完成了经德国验证的澳大利亚盆底问卷。比较术前的解剖学支持和肠道症状与术后值。
共有112名女性符合手术矫正标准。大多数（87%）有Ⅱ期后盆腔脏器脱垂，只有10%在腹腔镜骶骨阴道固定术期间同时进行了后盆腔修复。与术前相比，术后所有部位均出现显著（<0.001）的客观改善（Ba：0（-1/2）对-3（-3/-2），C：-1（-2/0）对-8（-12/-7），Bp：0（-1/0）对-3（-2/-2）；中位数（四分位数间距））。4%的病例需要因持续性直肠膨出和/或排便出口症状进行后续手术。经德国验证的澳大利亚盆底问卷中的大多数肠道特异性问题显示出显著改善（<0.001）。
单独的保留神经的骶骨阴道固定术似乎是矫正多部位脱垂（包括≥Ⅱ期直肠膨出）的合适手术方法，并可减少盆腔器官脱垂的客观体征和症状。
