Kortman Mart C P, Vanstiphout Jan W P, Alhafidh Akeel, Simonis Frank F J, Grob Anique T M
Multimodality Medical Imaging (M3i) Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
Department of Gynecology, Ziekenhuisgroep Twente, Hengelo, The Netherlands.
Colorectal Dis. 2025 May;27(5):e70114. doi: 10.1111/codi.70114.
Rectopexy with concomitant sacrocolpopexy (sacrocolporectopexy) is the favoured technique for treating combined pelvic organ prolapse and internal or external rectal prolapse, despite limited functional improvement. Previous studies have assessed anatomical change after standalone rectopexy or sacrocolpopexy, based on supine MRI defaecography. Since a supine position can underestimate the extent of pelvic organ prolapse, it might also incorrectly assess the anatomical effect of sacrocolporectopexy. The aim of this study was to assess the effect of sacrocolporectopexy on the pelvic anatomy in an upright position.
Twenty one female patients undergoing sacrocolporectopexy from December 2022 to June 2024 were included. All patients underwent physical examination and MRI defaecography preoperatively and postoperatively. The descent of the bladder, vaginal vault and anorectal junction and the size of the rectocele and enterocele were assessed on the MRI defaecography images during maximum straining. Significance was tested using a paired t-test and an improvement of ≥10 mm was considered clinically relevant. The results were compared with previous studies, which used supine assessment.
Postoperative improvement was found for the bladder, vaginal vault, anorectal junction, rectocele and enterocele with 14, 44, 5, 16 and 54 mm respectively. The bladder, vaginal vault, rectocele and enterocele showed clinically relevant improvement. Compared with supine results, upright assessments revealed a larger organ lift for the vaginal vault as well as a higher, overall, position of the anorectal junction.
Upright assessment of sacrocolporectopexy differs from supine assessment, with statistical and clinically relevant lift for the pelvic organs.
尽管功能改善有限，但直肠固定术联合骶骨阴道固定术（骶骨直肠阴道固定术）仍是治疗合并盆腔器官脱垂及直肠内脱垂或外脱垂的首选技术。既往研究基于仰卧位磁共振成像排粪造影评估了单纯直肠固定术或骶骨阴道固定术后的解剖学变化。由于仰卧位可能会低估盆腔器官脱垂的程度，因此也可能错误地评估骶骨直肠阴道固定术的解剖学效果。本研究的目的是评估骶骨直肠阴道固定术在直立位对盆腔解剖结构的影响。
纳入2022年12月至2024年6月期间接受骶骨直肠阴道固定术的21例女性患者。所有患者在术前和术后均接受了体格检查和磁共振成像排粪造影。在最大用力时，根据磁共振成像排粪造影图像评估膀胱、阴道穹窿和直肠肛管连接处的下移情况以及直肠膨出和肠膨出的大小。采用配对t检验进行显著性检验，改善≥10 mm被认为具有临床相关性。将结果与之前采用仰卧位评估的研究进行比较。
术后膀胱、阴道穹窿、直肠肛管连接处、直肠膨出和肠膨出分别改善了14、44、5、16和54 mm。膀胱、阴道穹窿、直肠膨出和肠膨出均显示出具有临床相关性的改善。与仰卧位结果相比，直立位评估显示阴道穹窿的器官提升更大，直肠肛管连接处的整体位置也更高。
骶骨直肠阴道固定术的直立位评估与仰卧位评估不同，盆腔器官有统计学意义且具有临床相关性的提升。
