Cundiff G W, Harris R L, Coates K, Low V H, Bump R C, Addison W A
Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina 27710, USA.
Am J Obstet Gynecol. 1997 Dec;177(6):1345-53; discussion 1353-5. doi: 10.1016/s0002-9378(97)70074-7.
Our purpose was to assess a modification of abdominal sacral colpopexy in 19 patients.
The rectovaginal space was dissected to the superior aspect of the posterior vaginal fascia still contiguous with the perineal body. Mersilene (Ethicon, Somerville, N.J.) mesh was sutured to this fascia and along the entire posterior vaginal wall. Patients with vault prolapse, perineal descent, and associated rectoceles or enteroceles are reported. Outcome measures included bowel symptoms and pelvic organ prolapse staging. Defecography was performed in three patients. Wilcoxon signed rank analysis was used for comparison of prolapse measures.
Mean follow-up was 11 weeks. Bowel symptoms improved in 8 of 11 women. No subjects had greater than stage II prolapse postoperatively and median improvement in stage was 3 (range 2 to 4). The mean decrease in the genital hiatus measurement was 3.13 +/- 1.25 (range 2 to 6) cm. Postoperative defecography documented correction of rectoceles and enteroceles and improvement in perineal descent with straining.
Abdominal sacral colpoperineopexy is effective surgery for vaginal vault prolapse associated with perineal descent and posterior vaginal defects.
我们的目的是评估对19例患者实施的改良腹骶阴道固定术。
将直肠阴道间隙解剖至与会阴体相连的阴道后筋膜上缘。将Mersilene（Ethicon公司，新泽西州萨默维尔）网片缝合至该筋膜及整个阴道后壁。报告了有穹窿脱垂、会阴下降以及相关直肠膨出或小肠膨出的患者。结果指标包括肠道症状和盆腔器官脱垂分期。对3例患者进行了排粪造影检查。采用Wilcoxon符号秩和分析对脱垂测量值进行比较。
平均随访11周。11例女性中有8例肠道症状改善。术后无患者脱垂程度超过II期，分期的中位数改善为3期（范围2至4期）。生殖裂孔测量值平均减小3.13±1.25（范围2至6）cm。术后排粪造影显示直肠膨出和小肠膨出得到纠正，用力排便时会阴下降情况改善。
腹骶会阴阴道固定术是治疗与会阴下降及阴道后壁缺损相关的阴道穹窿脱垂的有效手术。
