Hewson A D
Department of Obstetrics and Gynaecology, John Hunter Hospital, Newcastle, New South Wales.
Aust N Z J Obstet Gynaecol. 1998 Aug;38(3):318-24. doi: 10.1111/j.1479-828x.1998.tb03076.x.
This study assesses the results of transvaginal sacrospinous colpopexy in the treatment of posthysterectomy vault prolapse; 114 of 135 women were available for follow-up between 8 months and 5 years after surgery. There was an initial overall satisfaction rate of approximately 90% and this was maintained at 80% even beyond 4 years. Those initially complaining of a lump or a swelling were relieved of the symptom in almost 90% of cases. Those with a drag or ache were cured in approximately 80% of cases. There was greatly improved bowel function in approximately 60% of patients and in approximately 60% there was cure of stress incontinence with additional buttressing sutures. Frequency and/or urgency was relieved in over 50% of the group and there was more comfortable intercourse in approximately 35% of those in whom this was a problem initially. As in previous series, subsequent prolapse is more likely to be in the anterior vaginal wall and there was an approximately 5% risk of this occurring over this period of follow-up. The variation in technique in this series in which nonabsorbable Ethibond sutures were used to secure the vaginal vault to the sacrospinous ligament, appears to provide better long-term vault support than previous reports in the literature, without altering morbidity. Continuing follow-up will be required to confirm that this will prove to be so in the longer term. This series therefore confirms that the operation produces long-term support of the vaginal vault with preservation of a functional vagina, and has a satisfactory success rate in the relief of bladder and bowel symptoms associated with vault prolapse. However, it also demonstrates that in this mostly aged group of patients there will be a significant minority with limited relief of symptoms. It is important therefore that appropriate preoperative counselling is carried out so that patients have realistic expectations regarding the medium and long-term results of this procedure.
本研究评估经阴道骶棘韧带固定术治疗子宫切除术后阴道穹窿脱垂的效果；135名女性中有114名在术后8个月至5年期间接受了随访。术后初期总体满意率约为90%，即使超过4年，这一满意率仍维持在80%。最初抱怨有肿块或肿胀的患者，近90%的症状得到缓解。有坠胀或疼痛的患者，约80%得到治愈。约60%的患者肠道功能有显著改善，约60%的患者通过额外的支撑缝合治愈了压力性尿失禁。超过50%的患者尿频和/或尿急症状得到缓解，约35%最初有性交不适问题的患者性交时感觉更舒适。与之前的系列研究一样，后续脱垂更可能发生在阴道前壁，在该随访期间发生这种情况的风险约为5%。本系列研究采用不可吸收的Ethibond缝线将阴道穹窿固定于骶棘韧带上，与文献中之前的报道相比，该技术似乎能提供更好的长期穹窿支撑，且不改变发病率。需要持续随访以确认从长期来看情况确实如此。因此，本系列研究证实该手术能对阴道穹窿提供长期支撑，保留功能性阴道，并且在缓解与穹窿脱垂相关的膀胱和肠道症状方面成功率令人满意。然而，研究也表明，在这个以老年患者为主的群体中，会有相当一部分患者症状缓解有限。因此，进行适当的术前咨询非常重要，以便患者对该手术的中长期效果有现实的期望。
