梯形缝合法阴道紧缩术应用探讨

目的:探究阴道缩窄术的最佳手术方式。方法:采用梯形缝合法即对阴道后壁呈梯形样三层缝合使阴道下1/3段及阴道口肌肉紧缩的手术方式。结果:治疗30例,阴道松弛症状均取得了良好的矫治效果。结论:梯形缝合法将直肠筋膜、阴道周围缩紧加强的同时,更着重于加强阴道外1/3段,特别是近阴道口肌肉的力量使其更加符合生理特性,提高性生活的质量。该法是治疗阴道松弛症较好的手术方法。     

自体阴道瓣"桥"式缝合治疗阴道松弛20例

目的 寻找一种有效治疗阴道前壁松弛,减少尿失禁发生的方法.方法 采用自体阴道前壁瓣作材料,"桥"式缝合加固阴道前壁,缩窄阴道腔.结果 本组共20例患者,术后随访6～12个月,尿失禁明显改善,阴道缩紧,效果满意.结论 自体阴道瓣桥式缝合法可以矫正阴道松弛,提高患者性生活的质量,治疗女性压力性尿失禁,简单有效.     

埋没导引针缝合法和阴道后壁黏膜切除法治疗阴道松弛的临床比较

阴道松弛是女性随着年龄增长而出现的一种生理状况,常因妊娠或分娩使阴道骨盆底肌肉及筋膜的拉伤导致阴道盆地损伤,或由于年龄增大,雌激素水平下降致阴道黏膜萎缩、盆底组织松弛,从而导致阴道肌肉收缩力下降,阴道口变宽大于3指,严重影响性生活质量。笔者自2007-2013年应用埋没导引针缝合法。和阴道后壁黏膜切除法的阴道紧缩术,对71例阴道松弛患者进行了手术治疗。现将2种手术方法进行对比分析。     

保留完整粘膜阴道紧缩术方法的改良

随着我国经济、文化及整形外科发展,妇科整形越来越受到人们关注,由于分娩、年龄增长及长期性生活导致阴道松弛要求手术改善性生活质量的患者明显增加。目前临床上阴道紧缩术大部分在妇产科治疗张力性尿失禁、子宫脱垂阴道前后壁修补术基础上改进而来。自2003年以来,我们对23例     

阴道旁修补术联合球海绵体肌缝合治疗重度阴道松弛症

目的 探讨重度阴道松弛症的修复方法 及临床效果.方法 对48例重度阴道松弛症患者经阴道旁筋膜修补及球海绵体肌缝合,并随访术后性生活满意度、会阴外观、不自主排尿及阴道分泌物的改善效果.结果 术后随访43例,性满意度改善者40例,有效率为93%.14例对自身会阴外观不满意者术后均有明显改善;不自主排尿、阴道分泌物增多等症状有效缓解.结论 阴道旁修补术联合球海绵体肌缝合治疗重度阴道松弛症,手术安全,疗效可靠.     

保全阴道粘膜的阴道紧缩术

目的：对不损伤阴道粘膜的阴道紧缩手术进行部分改良，以提高手术效果。方法：手术应用紧贴阴道粘膜的钝性与锐性相结合的分离，在阴道松弛肌肉的两侧壁缝合紧缩，多余的阴道粘膜形成斜行的粘膜瓣，置于阴道内。结果：1999年至2004年共施术26例，取得良好手术效果。结论：经过改良的保全阴道粘膜的阴道紧缩手术是一种安全有效的手术方法。     

阴道后壁环肌紧缩术治疗产后阴道松弛症

目的：探讨一种有效治疗产后阴道松弛症的手术方法。方法：对阴道后壁撕裂松弛的肌肉由内向外采用水平褥式紧缩缝合法,缩小阴道直径;由深至浅,采用纵向紧缩缝合法,缩小阴道口并延长会阴体。结果：将此法用于56例产后阴道松弛症患者,手术全部成功。术后随访6～12个月,患者无不适感,术后效果满意。结论：阴道后壁环肌紧缩术治疗产后阴道松弛症,既达到解剖上的缩窄,同时也达到功能的康复,效果确切。     

保留阴道黏膜阴道紧缩术97例报告

目的 介绍一种保留阴道黏膜的阴道紧缩术方法.方法 于阴道口处女膜痕外5 mm处行切口,不切除阴道黏膜,紧缩阴道侧后壁肌肉,连续褥式缝合剥离阴道黏膜及黏膜下组织,将保留的阴道黏膜及黏膜下组织突入阴道.结果 本组共97例患者,术后随访3个月至6年,均感术后性生活满意,效果良好.结论 该手术方法操作简单,疗效确切、可靠,值得临床推广应用.     

改良自体原位阴道前壁吊带治疗女性压力性尿失禁(附10例报告)

目的:探讨改良自体阴道前壁吊带治疗女性压力性尿失禁(SUI)的可行性及近期疗效。方法:参照TVT-O设计原理,采用自体原位阴道壁吊带治疗女性压力性尿失禁患者10例。取自体阴道壁吊带,将阴道壁吊带两端缝合于盆筋膜腱弓,无需特殊手术器械经闭孔穿刺。结果:10例患者都顺利完成手术,手术平均时间65min,术中平均出血约35ml。无一例出现假性囊肿、感染等并发症。住院时间4～7d,平均5d,术后10例患者尿失禁症状消失,无需配戴尿垫,患者主诉满意。随访9个月～2年,1例术后3个月时复发;1例术后出现排尿困难,给予导尿及药物治疗后症状改善。结论:自行设计改良的自体阴道壁吊带治疗女性压力性尿失禁安全可行,效果同TVT-O手术,但手术费用低。阴道壁吊带是自身组织,避免了TVT-O手术的尿道吊带侵蚀反应的发生。本组病例较少,长期疗效需进一步随诊观察。     

不损伤粘膜的阴道紧缩术29例

本文报道的方法不切开阴道粘膜 ,势必给手术暴露及操作带来一定的困难 ,对合并有直肠膨出者 ,将不利于直肠前筋膜较高位置的缝合 (而不是阴道后壁肌肉 )从而可能影响手术效果。粘膜游离过多可能会引起阴道后壁皱壁过大和粘膜下血肿。     

A new needle suspension procedure for genuine stress incontinence and anterior vaginal wall prolapse

A new suspension method was developed for the correction of anterior vaginal wall relaxation and genuine stress incontinence. This procedure suspends the anterior vaginal wall to the anterior rectus fascia, and in doing so gives support to the bladder neck, anterior vaginal wall and vaginal apex. The procedure is performed at the time of vaginal hysterectomy or correction of anterior vaginal wall relaxation. The authors present their experience with this technique in 31 patients.Editorial Comment: Numerous types of surgery for the simultaneous correction of stress incontinence and cystocele and/or procidentia have been described in the literature. Some have proved more efficient for the correction of stress incontinence and others for the correction of disturbed pelvic support. The authors use the known method of needle suspension for the correction of stress incontinence, but for the new purpose of correction of cystocele/procidentia and stress incontinence. If necessary, vaginal hysterectomy can be performed with the originally planned intervention. As the criterion of an efficient outcome for the correction of genital statics, the author uses a vaginal depth of greater than 5 cm, which is less than normal. The successful correction of genital statics after 24 months was reported to be 93%, which is an extremely favorable result, resembling the success rate achieved by much more complicated surgeries (e.g. sacrospinous vault fixation or fixation of the vagina to the sacrum). The successful correction of stress incontinence in 82% of patients after 24 months is also favorable, and comparable to the results achieved by other surgical methods of needle suspension for the correction of stress incontinence.     

Anterior vaginal wall hammock with fascia lata for the correction of stage 2 or greater anterior vaginal compartment relaxation

PURPOSE: We determined the efficacy of the anterior vaginal wall hammock (AVWH) using fascia lata for the correction of anterior vaginal compartment relaxation. MATERIALS AND METHODS: A total of 58 patients with stage 2 or greater anterior vaginal compartment relaxation underwent an AVWH procedure with autologous or allograft fascia lata from June 1998 to March 2001. Patients were evaluated preoperatively with a history and pelvic organ prolapse quantitative examination. Postoperatively patients were evaluated at 6 weeks, 6 months and yearly thereafter with pelvic organ prolapse quantitative staging of the anterior, middle and posterior compartments. Objective cure was defined as stage 0 or 1 relaxation. Subjective cure was defined as no symptoms of pelvic pressure or a vaginal bulge. RESULTS: Of the 69 (89%) patients who underwent surgery 58 were available for followup. Median age of the population was 61.9 years and median followup was 24.7 months (range 12 to 57). There were 11 objective failures (19%) in the anterior compartment, of which 1 (2%) was symptomatic. Two patients (4%) had enteroceles that required surgical correction. Of the patients 16 (28%) had new onset or worsening stage 2 posterior relaxation at a median of 15.2 months postoperatively, including 7 (12%) who were symptomatic and underwent subsequent repair. CONCLUSION: The AVWH procedure with fascia lata is safe and effective for correcting stage 2 or greater anterior compartment relaxation. The whole pelvic floor must be evaluated and repaired to minimize the progression of prolapse of the middle and posterior compartments.     

子宫脱垂患者行阴式子宫切除术联合阴道前后壁修补术后合并新发性压力性尿失禁的影响因素

目的探究子宫脱垂患者行阴式子宫切除术联合阴道前后壁修补术术后合并压力性尿失禁的相关影响因素,为子宫脱垂患者的个体化治疗提供临床参考依据。 方法选取2017年1月至2019年1月,天长市中医院住院行阴式子宫切除术联合阴道前后壁修补术的患者50例,术前患者已排除急性尿失禁、压力性尿失禁等情况,术后所有患者均顺利出院,术后随访2个月,根据患者的主观症状,体格检查结果、国际尿失禁咨询委员会尿失禁问卷简表以及尿动力学检查诊断并统计术后新发压力性尿失禁患者并对可能造成术后新发压力性尿失禁的因素进行统计分析。 结果（1）子宫脱垂患者行阴式子宫切除术联合阴道前后壁修补术治疗后新发压力性尿失禁患者15例,其中主观症状较为明显患者5例,主观症状及体格检查均无明显异常患者6例,完成问卷量表后方才明确诊断,经尿动力学检查方才明确诊断患者4例。（2）单因素分析发现糖尿病史、体质量指数、巨大胎儿分娩史、盆腔手术史是影响术后新发压力性尿失禁的相关影响因素。（3）以术后是否发生尿失禁作为因变量（0=未发生,1=发生）,将单因素分析中有统计学差异的4个影响因素纳入多因素Logistic回归分析,结果显示糖尿病病史、盆腔手术病史以及巨大胎儿分娩史是阴式子宫切除联合阴道前后壁修补术术后新发压力性尿失禁的独立危险因素。 结论对于合并巨大胎儿分娩史、盆腔手术史、糖尿病病史的子宫脱垂患者可于术前加强与患者的沟通交流,告知患者术后出现新发压力性尿失禁的风险,并在完善相关评估后建议患者同步性抗尿失禁手术以综合改善患者预后,提高患者术后生活质量。     

小切口保留完整粘膜阴道紧缩术

目的:探究阴道缩窄的最佳手术方式。方法:采用小切口并保留完整阴道粘膜的术式,对阴道后壁多层缝合,使阴道外1/3及阴道口得以收紧。结果:将此法应用于105例阴道松弛患者,手术全部成功,术后随访0.5～3年,效果满意。结论:小切口保留完整粘膜阴道紧缩术在收紧阴道肌肉的基础上,着重于对阴道外1/3及阴道口的收紧,更符合生理特性,提高性生活质量,效果确切。     

Sacral colpopexy using mersilene mesh in the treatment of vaginal vault prolapse

We report the efficacy and safety of abdominal sacral colpopexy using Mersilene mesh to treat vaginal vault prolapse. A total of 61 patients underwent sacral colpopexy to treat vaginal vault prolapse of whom 58 were available for evaluation. The procedure utilizes an abdominal approach to expose the vaginal vault and the anterior surface of the first and second sacral vertebrae. A Mersilene mesh is fastened to the anterior and posterior vaginal walls then anchored to the sacrum without tension. Hysterectomy and posterior colporrhaphy were performed as indicated. Concomitant anti-incontinence surgery was performed in 52 patients: 41 underwent Burch colposuspension, and 11 had pubovaginal sling placement. To assess long-term subjective and clinical efficacy, patients completed a questionnaire and underwent pelvic examination at least 1 year following surgery. The resolution of symptoms, objective restoration of normal pelvic support, and urinary continence defined surgical success. Median patient age at operation was 62 years. Previous operations included 29 hysterectomy procedures, five failed sacrospinous fixation, and 12 failed anti-incontinence procedures. The total complication rate was 15%. With a median follow-up of 26 months, complete correction of vaginal prolapse was found in 91% of patients. Vaginal symptoms were relieved in 90% of patients and 88% of patients had resolution of their urinary incontinence. Ninety percent of patients were satisfied with the surgery and would recommend it to others. Sacral colpopexy using Mersilene mesh relieves vaginal vault symptoms, restores vaginal function, and provides durable pelvic support.     

双菱形缝线法阴道紧缩术

目的介绍一种即微创又有效的阴道紧缩手术。方法采用打孔器在会阴处打6个小孔,将2根双向倒齿线经小孔对盆底肌肉行双菱形法缝合,收紧盆底肌肉,缩小阴道口。结果本组20例患者手术时间为30~40 min,平均35 min。出血量较少,无瘢痕形成。获随访6个月,性生活满意度较术前有所提高。结论采用双菱形缝线法阴道紧缩术,设计科学,损伤小,不遗留瘢痕,且并发症较少,是改善阴道松弛及提高患者性生活质量的简单而有效的手术方法。     

阴式子宫切除术联合阴道前后壁修补术对子宫脱垂合并阴道壁膨出患者术后疼痛及复发的影响

目的探讨阴式子宫切除术联合阴道前后壁修补术对子宫脱垂合并阴道壁膨出患者术后疼痛及复发的影响。 方法选取2017年1月到2019年1月,安徽省马鞍山市中心医院收治的90例子宫脱垂合并阴道壁膨出患者。采用随机数字表法将其分为对照组和观察组。对照组45例采用单纯阴道前后壁修补术进行治疗,观察组45例采用阴式子宫切除术联合阴道前后壁修补术进行治疗,2组术后随访1年。比较2组治疗后的临床疗效及手术前后视觉模拟评分（VAS）;统计2组围手术期手术相关指标及并发症发生率和随访1年的复发率。采用SPSS 21.0统计软件进行数据分析。 结果观察组总有效率为93.33%,显著高于对照组的71.11%,差异有统计学意义（P<0.05）。与手术前相比,术后3～7 d,2组VAS评分均呈逐渐降低趋势,且术后3、7 d观察组显著低于对照组,差异有统计学意义（P<0.05）。与对照组相比,观察组术中出血量明显较少,差异有统计学意义（P<0.05）;观察组的住院时间、肛门排气时间、手术时间等明显较短,差异有统计学意义（P<0.05）。观察组并发症发生率、随访1年复发率分别为6.67%、2.22%,显著低于对照组的26.67%、24.44%,差异有统计学意义（P<0.05）。 结论阴式子宫切除术联合阴道前后壁修补术治疗子宫脱垂合并阴道壁膨出,可显著改善患者围手术期相关指标的情况,减轻患者术后疼痛,并能降低患者并发症发生率及术后复发率,临床疗效显著。     

Delayed vaginal and urethral mesh exposure: 10 years after TVT surgery

Delayed mesh exposure after tension-free vaginal tape (TVT) procedure is rare. We report a case of mesh exposure into the vagina and urethra that developed 10 years after TVT surgery. A 58-year-old postmenopausal woman presented with mixed urinary incontinence. She was investigated, and her stress urinary incontinence was cured with a TVT procedure 10 years ago. She was then scheduled follow-up annually. Two years postsurgery, a granulation tissue was observed and excised at the vaginal incision site. Vaginal examination 10 years postsurgery showed vaginal mesh erosion 0.5 cm from urethral meatus. Cystoscopy revealed concomitant urethral erosion at the posterior urethral wall. Mesh excision was performed, and urethra and vagina were repaired in layers. Postoperative recovery was uneventful. This finding shows that, although rare, complications can occur even after 10 years of TVT surgery.     

岛状阴股沟皮瓣阴道形成术的临床应用

目的 介绍岛状阴股沟皮瓣的解剖学基础及临床应用。方法 以阴唇后血管神经束为蒂在邻近大阴唇之阴肥沟区设计岛状阴股沟皮瓣。结果 自1993～2001年共用以行阴道形成术47例，获得满意效果。结论 岛状阴股沟皮瓣血运丰富，易成活，转移时带有部分感觉神经，并发症少，是形成阴道的理想术式。