Weber A M, Walters M D
Department of Gynecology and Obstetrics, Cleveland Clinic Foundation, Ohio, USA.
Obstet Gynecol. 1997 Feb;89(2):311-8. doi: 10.1016/S0029-7844(96)00322-5.
To summarize the literature on anterior vaginal prolapse, focusing on vaginal anatomy, etiologic theories, and comparison of anterior colporrhaphy and paravaginal repair.
We identified articles related to anterior vaginal prolapse through a MEDLINE search of English-language literature published from January 1966 through December 1995 and in bibliographies in gynecologic textbooks.
We reviewed 80 articles published in peer-reviewed journals or textbooks and related to anterior vaginal prolapse. In addition, ten articles on operative procedures for urinary incontinence were studied.
TABULATION, INTEGRATION, AND RESULTS: We abstracted and synthesized information from 31 papers that contained descriptions of and opinions on vaginal anatomy and etiology of vaginal prolapse. The vagina has three layers-mucosa, muscularis, and adventitia; there is no vaginal "fascia." Vaginal support is provided by the underlying levator ani muscles and by lateral connective-tissue attachments at the arcus tendineus fasciae pelvis or "white line." Anterior vaginal prolapse results from direct or indirect damage to the pelvic muscles or connective tissue or both. Forty-nine articles described surgical techniques for the correction of anterior vaginal prolapse, and 24 of them reported postoperative outcomes. Reported failure rates ranged from 0-20% for anterior colporrhaphy and 3-14% for paravaginal repair. No controlled studies compared different procedures performed primarily for correction of anterior vaginal prolapse.
Dissection during anterior colporrhaphy splits vaginal muscularis, and repair involves plication of the muscularis and adventitia (not vaginal "fascia") in the midline, which may pull the lateral attachments further from the pelvic sidewall. Paravaginal repair restores the lateral attachments to the pelvic sidewall at the white line. Controlled studies that compare directly these two procedures for anterior vaginal prolapse repair are necessary to determine their relative effectiveness.
总结有关阴道前壁脱垂的文献，重点关注阴道解剖结构、病因学理论以及阴道前壁修补术和阴道旁修补术的比较。
通过检索1966年1月至1995年12月发表的英文医学文献数据库MEDLINE以及妇科教科书的参考文献，我们确定了与阴道前壁脱垂相关的文章。
我们回顾了80篇发表在同行评审期刊或教科书中且与阴道前壁脱垂相关的文章。此外，还研究了10篇关于尿失禁手术操作的文章。
制表、整合与结果：我们从31篇包含阴道解剖结构及阴道脱垂病因描述和观点的论文中提取并综合了信息。阴道有三层结构——黏膜层、肌层和外膜层；不存在阴道“筋膜”。阴道的支撑由其下方的肛提肌以及盆筋膜腱弓或“白线”处的外侧结缔组织附着提供。阴道前壁脱垂是由盆腔肌肉或结缔组织或两者的直接或间接损伤导致的。49篇文章描述了纠正阴道前壁脱垂的手术技术，其中24篇报告了术后结果。报道的阴道前壁修补术失败率为0%至20%，阴道旁修补术为3%至14%。没有对照研究比较主要用于纠正阴道前壁脱垂的不同手术方法。
阴道前壁修补术中的解剖操作会分离阴道肌层，修复涉及在中线处折叠肌层和外膜层（而非阴道“筋膜”），这可能会使外侧附着点进一步远离盆腔侧壁。阴道旁修补术可将外侧附着点恢复至白线处的盆腔侧壁。需要进行直接比较这两种阴道前壁脱垂修复手术的对照研究，以确定它们的相对有效性。
