Ostrzenski A
Department of Obstetrics and Gynecology, Howard University, College of Medicine and University Hospital, Washington, DC, USA.
Int J Gynaecol Obstet. 1995 Apr;49(1):25-34. doi: 10.1016/0020-7292(94)02304-h.
A new surgical technique of creating a prophylactic, reconstructive posterior culdoplasty and vaginal vault suspension during abdominal hysterectomy is described. The procedure restores the pelvic topography and gross and functional anatomy after removal of the uterus. A systematic order of the operation, its safety and effectiveness are presented and illustrated.
This surgical technique has been studied for 10 years, from 1983 to 1993, in a group of 250 patients with ages ranging from 19 to 76 years, average age 43 years (Caucasian, n = 178; black, n = 61; and Asian, n = 11). The following new elements were introduced to achieve post-hysterectomy restoration of the posterior cul-de-sac and vaginal vault suspension: the deep layer of the uterosacral ligaments and pararectal-paravaginal fascia are incorporated for reconstructive posterior culdoplasty; the cardinal ligaments and the deep and superficial layers of the uterosacral ligaments are used for anatomical vaginal vault suspension from the latero-posterior aspect of the vaginal wall.
This study has documented a good outcome and effectiveness of the operation as well as good postsurgical patient satisfaction, with no symptomatology or signs of dysfunctional vagina, vaginal prolapse or enterocele formation.
This new prophylactic procedure is effective, safe, simple to learn, easy to carry out, and adds very little on to the overall surgical time. Restoration of the pelvic topography, functional anatomy, prevention of dysfunctional vagina, vaginal prolapse and pelvic hernia (enterocele) formation can be achieved by following this technique. Post-hysterectomy dysfunctional vagina, vaginal prolapse and pelvic hernia formation are preventable occurrences when a surgical operation is appropriately selected and properly executed.
描述一种在腹式子宫切除术中创建预防性、重建性后穹窿成形术和阴道穹窿悬吊术的新手术技术。该手术在切除子宫后恢复盆腔形态以及大体和功能解剖结构。介绍并展示了手术的系统步骤、安全性和有效性。
1983年至1993年，对一组年龄在19岁至76岁之间、平均年龄43岁的250例患者（白种人178例、黑人61例、亚洲人11例）研究了该手术技术。为实现子宫切除术后后穹窿的恢复和阴道穹窿悬吊，引入了以下新要素：将子宫骶韧带深层和直肠旁 - 阴道旁筋膜用于重建性后穹窿成形术；将主韧带以及子宫骶韧带的深层和浅层用于从阴道壁的后外侧进行解剖学阴道穹窿悬吊。
本研究记录了该手术良好的结果和有效性，以及术后患者的高度满意度，未出现阴道功能障碍、阴道脱垂或肠疝形成的症状或体征。
这种新的预防性手术有效、安全、易于学习、易于实施，并且对总手术时间增加很少。遵循该技术可实现盆腔形态、功能解剖结构的恢复，预防阴道功能障碍、阴道脱垂和盆腔疝（肠疝）形成。当适当选择并正确实施手术时，子宫切除术后的阴道功能障碍、阴道脱垂和盆腔疝形成是可预防的情况。
