Nezhat C H, Nezhat F, Seidman D S, Nezhat C
Department of Gynecology and Obstetrics, Stanford University School of Medicine, California, USA.
Obstet Gynecol. 1996 May;87(5 Pt 2):868-70.
Vaginal vault rupture with intestinal herniation, although rare, is a recognized postoperative complication of vaginal and abdominal hysterectomies. The incidence after laparoscopic hysterectomy is unknown.
Three women, ages 40-43 years, presented to the emergency room with bleeding and pain 2-5 months after total laparoscopic hysterectomy. The small bowel was visible through the introitus or protruding into the vagina. Inspection of the bowel revealed no evidence of trauma. Two vaginal cuff repairs were completed transvaginally and one laparoscopically, all with interrupted sutures of no. 0 polydioxanone or polyglactin. In follow-up period of 12-17 months, the patients were doing well.
Total laparoscopic hysterectomy may be associated with an increased risk of vaginal vault evisceration. Because laparoscopy increasingly is used to replace abdominal hysterectomy, it is important to be aware of this complication and its management.
阴道穹窿破裂伴肠疝形成，虽较为罕见，但却是阴道和腹部子宫切除术后公认的并发症。腹腔镜子宫切除术后的发生率尚不清楚。
三名年龄在40 - 43岁的女性，在全腹腔镜子宫切除术后2 - 5个月因出血和疼痛就诊于急诊室。小肠可经阴道口看见或突出至阴道内。检查肠道未发现创伤迹象。经阴道完成了两例阴道断端修补术，一例经腹腔镜完成，均采用0号聚二氧六环酮或聚乙交酯缝线间断缝合。在12 - 17个月的随访期内，患者情况良好。
全腹腔镜子宫切除术可能会增加阴道穹窿脏器脱出的风险。由于腹腔镜手术越来越多地用于替代腹部子宫切除术，了解这一并发症及其处理方法很重要。
