Robert H G, Elhaik S
J Chir (Paris). 1980 Oct;117(10):513-7.
A series of 150 operations, by the same surgeon, for genital prolapse in women over 60 years of age (range to 85 years), represented 36% of the total number of operations for prolapse performed. A total of 32 women had had previous prolapse operations, 24 developed prolapse after hysterectomy, and 11 had postoperative colpoceles. This means that 45% had iatrogenic lesions, term in fashion at the present time but which strongly emphasizes the role played by insufficiently defined operative indications, and operations conducted without sufficient rigour. The most frequent lesions, were firstly cystoceles, then external prolapses, followed by hysteroceles. Urinary incontinence was evident in 15%, and potential in at least 10% of continent women. The lower approach was employed for the operation, either obturating or conservative, in most cases. When the upper approach was used, this was mainly for pathogenic purposes, and adapted to the lesion. Overall results were excellent, and only two irreversible accidents occurred. Recurrences were mainly in the form of cystoceles, micturition disorders, or sometimes rectocele sequelae. Increased life-span and improved operative treatment should make the surgery of prolapse in elderly women even more effective.
同一位外科医生为60岁以上(年龄范围为60至85岁)的女性进行了150例生殖器脱垂手术,占脱垂手术总数的36%。共有32名女性曾接受过脱垂手术,24名在子宫切除术后出现脱垂,11名有术后阴道膨出。这意味着45%的患者有医源性病变,这是目前流行的说法,但它强烈强调了手术指征定义不充分以及手术操作不够严谨所起的作用。最常见的病变首先是膀胱膨出,其次是外部脱垂,然后是子宫膨出。15%的患者存在尿失禁,至少10%的无尿失禁女性有潜在尿失禁风险。大多数情况下采用低位手术入路,无论是封闭性手术还是保守性手术。当采用高位手术入路时,主要是为了治疗病因,并根据病变情况进行调整。总体效果良好,仅发生了两起不可逆的意外情况。复发主要表现为膀胱膨出、排尿障碍,有时还会出现直肠膨出后遗症。预期寿命的延长和手术治疗的改进应会使老年女性脱垂手术的效果更加显著。