腹腔镜阴道骶骨固定术治疗女性盆腔器官脱垂的40例分析

目的探讨腹腔镜阴道骶骨固定术(laparoscopic sacrocolpopexy,LSC)治疗女性盆腔器官脱垂(pelvic organ prolapse,POP)的可行性和临床疗效。 方法选取首都医科大学附属北京安贞医院2015年1月至2017年12月因POP进行子宫切除并LSC治疗患者40例,采用POP-Q分期法和盆底功能障碍问卷表(PFDI-20)、盆底功能影响问卷表(PFIQ-7)、性功能调查问卷评分(PISQ-31)评价解剖及功能疗效。患者年龄45～77岁,平均(60.8±1.4)岁;孕1～4次,平均(2.8±0.7)次;产1～3次,平均(1.7±0.5)次。 结果手术时间130～330 min,平均(215.2±7.6)min;术中出血量20～300 ml,平均(82.3±9.2)ml;术后住院时间3～19 d,平均(6.6±0.4)d;术后阴道长度7.0～8.5 cm,平均7.5 cm;术后例随访8～21个月,平均11个月;术后客观无脱垂复发,客观治愈率为100%,术后自觉症状较术前改善,正常恢复性生活,主观满意度100%。 结论LSC在女性盆腔器官脱垂的治疗中客观治愈率高,术后性生活满意,有一定的临床疗效。     

机器人腹腔镜下阴道骶骨固定术治疗盆腔器官脱垂的疗效观察

目的:探讨机器人腹腔镜下阴道骶骨固定术治疗盆腔器官脱垂的临床效果。方法:回顾性分析2014年11月—2017年5月郑州大学第一附属医院完成的14例机器人腹腔镜下阴道骶骨固定术治疗盆腔器官脱垂患者的临床资料。女性14例,年龄48～79岁,平均63岁。体重指数19.5～28.6 kg/m~2,平均23.6 kg/m~2。临床表现为排尿困难伴阴道前壁膨出5例,子宫脱垂4例,尿失禁伴反复尿路感染3例,双肾积水2例。病程20～72个月,按照盆腔器官脱垂定量(POP-Q)分度法分为Ⅱ度3例、Ⅲ度9例、Ⅳ度2例。4例患者既往有子宫切除手术史。结果:14例手术过程顺利,3例压力性尿失禁患者同期行尿道中段悬吊术。手术时间110～185 min,平均135 min;手术失血量40～120 mL,平均85 mL;住院时间6～10 d,平均8 d。1例术后出现骶骨骨髓炎,经抗感染治疗后好转。术后随访2～29个月,平均16个月,患者阴道脱出物消失,5例排尿困难消失,3例压力性尿失禁治愈,2例肾积水消失。1例术后13个月复发,经二次手术治愈;术后新发尿失禁1例,经盆底肌锻炼后症状明显减轻。术后无网片腐蚀外露、无新发排尿困难病例。结论:机器人腹腔镜下阴道骶骨固定术治疗盆腔器官脱垂安全有效,但需警惕术前存在隐匿性尿失禁的可能。     

腹腔镜下子宫骶骨韧带缩短固定术治疗子宫脱垂疗效观察

目的探讨腹腔镜下子宫骶骨韧带缩短固定术治疗子宫脱垂临床疗效。方法对38例子宫脱垂患者实施腹腔镜下子宫骶骨韧带缩短固定术,回顾性分析患者的临床资料。结果 38例均顺利完成手术,手术平均时间(30±15)min、平均失血量(38±10)m L。患者术后均获6~12个月随访,总有效率92.1%(35/38)。结论腹腔镜下子宫骶骨韧带缩短固定术治疗子宫脱垂有效率高,并发症少,效果肯定。     

腹腔镜骶骨固定术相关并发症的回顾：7年单中心临床分析

目的回顾性分析重庆市妇幼保健院行腹腔镜骶骨固定术7年的临床资料,分析总结该术式的相关并发症及处理。 方法收集2012年1月至2019年11月接受腹腔镜骶骨固定术的238例患者的临床随访资料,统计分析手术前后POP-Q的Ba、Bp、C、D位点等各指示点及生存质量和性生活状态评分的变化,术后各类并发症的处理情况。 结果腹腔镜骶骨固定术治疗中盆腔缺陷的有效方式,其治愈率为98.74%;Ba、Bp、C、D位点,以及PFDI-20和PISQ-12问卷均有明显改善,术后生存质量及性生活状态改善。术后的并发症发生率约15.55%,其中便秘发生率最高(约5.04%),其次为疼痛3.78%,网片暴露、新发尿失禁、骶前出血、尿潴留的发生率均1.26%;复发、严重感染发生率0.84%,性生活障碍、输尿管折叠梗阻、尿道损伤发生率0.42%;所有并发症均经相应处理治愈。 结论腹腔镜骶骨固定术是治疗中盆腔缺陷的有效方式,效果满意,但需重视手术网片并发症的预防及处理,对并发症的合理治疗可以改善患者的预后。     

腹腔镜下髂耻韧带固定术在盆腔器官脱垂治疗的短期疗效

目的 分析腹腔镜下髂耻韧带固定术在盆腔器官脱垂治疗的短期疗效。方法 回顾性分析2020年3月至2022年6月在本院因盆腔器官脱垂而收入本院的患者46例的临床资料,按照患者接受的手术方式将其分为对照组和观察组各23例,对照组患者接受腹腔镜下骶骨固定术,观察组患者接受腹腔镜下髂耻韧带固定术。比较两组患者的手术指标、术前术后盆底功能状况和并发症情况。结果 观察两组患者的手术指标,对照组患者的手术时间和出血量均高于观察组患者,差异具备统计学意义（P<0.05）;两组患者的住院时间比较差异不显著,P>0.05。两组患者术前及术后盆底功能的比较,术前的盆底障碍影响简易问卷7(pelvic floor impact questionnaire-short form-7,PFIQ-7)和盆底功能障碍问卷（pelvic floor distress inventory-short form 20,PFDI-20）评分差异比较不具备统计学差异,P>0.05;两组患者术后的PFIQ-7和PFDI-20评分差异比较,观察组均优于对照组,差异具备统计学意义,P<0.05。两组患者术后的并...     

腹腔镜腹股沟韧带悬吊术与腹腔镜骶骨固定术治疗重度盆腔器官脱垂的疗效分析

目的:探讨腹腔镜腹股沟韧带悬吊术(LILS)与腹腔镜骶骨固定术(LSC)治疗重度盆底器官脱垂(POP)的临床疗效.方法:回顾分析2016年1月至2018年12月因重度POP行LILS的42例患者(LILS组)与行LSC的46例患者(LSC组)的临床资料,对比分析两组手术时间、术中出血量、术中与术后并发症及术前、术后1年...     

改良腹腔镜阴道骶前固定术治疗重度盆腔器官膨出及其并发症的处理和预防

1962年,Lane报道了经腹骶骨阴道固定术（Abdominal Sacrocolpopexy）治疗阴道穹窿膨出,之后这种术式就在临床逐渐应用起来。其后逐渐发展出保留子宫的骶骨固定术。被认为是治疗重度盆腔器官脱垂的经典金标准。随着人类寿命的延长和对生活质量要求的提高,腹腔镜手术已应用于该手术,因手术区域受限和诸多的镜下缝合延长了手术时间,增加了腔镜下手术的难度。     

合成网片对比阴道修补术治疗女性盆腔器官脱垂的meta分析

目的系统评价合成网片用于盆腔器官脱垂修补手术和阴道修补术的有效性和安全性。方法检索PubMed（1980～2013年）、Cochrane图书馆（1995～2013年）、GoogleScholar（1980～2013年）、中国期刊网全文数据库（1980～2013年）、中国生物医学文献数据库（1980～2013年）,纳入合成网片修补术和传统阴道修补术2种治疗方法的随机对照研究,并应用RevMan5．0软件进行统计分析。结果纳入10项随机对照试验,meta分析结果显示：合成网片组手术时间明显长于传统阴道修补组（IVMD：16．57min,95％CI：14．06—19．08mitt,P〈0．00001）,术中出血量明显多于传统阴道修补组（WMD：24．98ml,95％CI：7．13～42．84ml,P=0．006）,客观治愈率明显高于传统阴道修补组（D尺：4．16,95％cl：3．10-5．58,P〈0．00001）,主观治愈率明显高于传统阴道修补组（OR：2．13,95％CI：1．55—2．91,P〈0．00001）,性交困难发生率明显低于传统阴道修补组（P=0．04）,术后再发尿失禁、术后再次手术率无统计学差异（P=0．13,P=0．06）。结论与传统阴道修补术相比,合成网片提高主、客观治愈率,提示合成网片应用于治疗盆腔器官脱垂有效,但仍需高质量前瞻性研究进一步证实。     

腹腔镜直肠悬吊固定术治疗直肠重度脱垂

目的探讨腹腔镜直肠悬吊固定术治疗直肠脱垂的临床应用价值。方法1998年3月至2007年2月,对4例完全性直肠脱垂患者进行了腹腔镜直肠悬吊固定术。1例采用缝合固定法,将直肠后壁分离、提高,用丝线缝闭直肠前陷凹,并将直肠后壁悬吊固定于骶骨岬前筋膜上,再将乙状结肠缝合固定在左侧腰大肌筋膜。3例采用网片固定法,将直肠游离到肛提肌水平,用1张6cm×9cm的T字型聚丙烯网片置于直肠后方,网片下缘在肛提肌水平环绕直肠,在直肠前方用丝线缝合网片和直肠浆肌层,再将网片上端在直肠后用疝修补钉夹固定于骶骨岬前筋膜,缝合关闭盆底腹膜。再将乙状结肠缝合固定在左侧腰大肌筋膜。结果4例患者手术均顺利,无中转开腹者。手术时间92.5(80-100)min,出血量6.5(5～10)ml。无并发症发生。术后尿失禁和肛门失禁的症状缓解,术后随访2个月至3年均未见复发与便秘出现。结论腹腔镜下行腹腔镜直肠悬吊固定术创伤小、恢复快和安全有效。     

Efficacy of Laparoscopic Sacrocervicopexy for Apical Support of Pelvic Organ Prolapse

Background and Objectives:

To evaluate the efficacy of laparoscopic sacrocervicopexy for apical support in sexually active patients with pelvic organ prolapse.

Methods:

One-hundred thirty-five women with symptomatic prolapse of the central compartment (Pelvic Organ Prolapse Quantitative [POP-Q] stage 2) underwent laparoscopic sacrocervicopexy. The operating physicians used synthetic mesh to attach the anterior endopelvic fascia to the anterior longitudinal ligament of the sacral promontory with subtotal hysterectomy. Anterior and posterior colporrhaphy was performed when necessary. The patients returned for follow-up examinations 1 month after surgery and then over subsequent years. On follow-up a physician evaluated each patient for the recurrence of genital prolapse and for recurrent or de novo development of urinary or bowel symptoms. We define “surgical failure” as any grade of recurrent prolapse of stage II or more of the POP-Q test. Patients also gave feedback about their satisfaction with the procedure.

Results:

The mean follow-up period was 33 months. The success rate was 98.4% for the central compartment, 94.2% for the anterior compartment, and 99.2% for the posterior compartment. Postoperatively, the percentage of asymptomatic patients (51.6%) increased significantly (P < .01), and we observed a statistically significant reduction (P < .05) of urinary urge incontinence, recurrent cystitis, pelvic pain, dyspareunia, and discomfort. The present study showed 70.5% of patients stated they were very satisfied with the operation and 18.8% stated high satisfaction.

Conclusion:

Laparoscopic sacrocervicopexy is an effective option for sexually active women with pelvic organ prolapse.     

腹腔镜下经腹膜外阴道旁修补术治疗阴道前壁脱垂9例报告

目的探讨腹腔镜经腹膜外阴道旁修补术治疗阴道旁缺陷所致的阴道前壁脱垂的可行性及疗效。方法2010年7月～2011年10月行腹腔镜经腹膜外阴道旁修补术治疗阴道旁缺陷所致的阴道前壁脱垂9例（Ⅲ度4例,Ⅱ度1例,Ⅰ度4例;4例合并阴道后壁脱垂Ⅰ度）,腹腔镜下腹膜外暴露双侧盆侧壁盆筋膜腱弓（白线）及坐骨棘,阴道穹隆角缝合于同侧坐骨棘,将阴道侧壁缝合于同侧白线。需行子宫全切及阴道壁修补术的患者同时行相应手术,但行阴道壁修补时不去除阴道壁。结果同时行阴式全子宫切除及阴道前后壁修补术4例,阴式全子宫切除1例,阴道前壁修补1例。手术时间75～310 min,平均177 min。除1例术中出血500 ml外,其余患者出血量中位数60 ml（5～280 ml）。术中均无并发症发生。3例术后出现臀部及下肢痛,除1例下肢痛持续2个月外,其余患者持续5～7 d后缓解。术后住院2～11 d,平均6 d。9例术后随访6～15个月,平均8个月,7例主观治愈及客观治愈。1例术后6个月感觉阴道肿物脱出,妇科检查为子宫脱垂Ⅰ度、阴道前壁脱垂Ⅰ度;1例术后1年感觉阴道肿物脱出,妇科检查为阴道前壁脱垂Ⅰ度。所有患者术后阴道深度均〉7 cm。结论腹腔镜经腹膜外阴道旁修补术治疗阴道旁缺陷所致的阴道前壁脱垂安全、可行,能保留阴道的原有深度,近期疗效好。     

Robot-assisted Sacrocolpopexy for Pelvic Organ Prolapse: A Systematic Review and Meta-analysis of Comparative Studies

Context

Surgery represents the mainstay of treatment for pelvic organ prolapse (POP). Among different surgical procedures, abdominal sacrocolpopexy (SC) is the gold standard for apical or multicompartmental POP. Research has recently focused on the role of robot-assisted sacrocolpopexy (RASC).

Objective

To conduct a systematic review on the outcomes of RASC.

Evidence acquisition

PubMed, Scopus, and Web of Science databases as well as ClinicalTrials.gov were searched for English-language literature on RASC. A total of 509 articles were screened; 50 (10%) were selected, and 27 (5%) were included. Studies were evaluated per the Grading of Recommendations, Assessment, Development, and Evaluation system and the European Association of Urology guidelines.

Evidence synthesis

Overall, data on 1488 RASCs were collected from 27 studies, published from 2006 to 2013. Objective and subjective cures ranged from 84% to 100% and from 92% to 95%, respectively. Conversion rate to open surgery was <1% (range: 0–5%). Intraoperative, severe postoperative complications, and mesh erosion rates were 3% (range: 0–19%), 2% (range: 0–8%), and 2% (range: 0–8%), respectively. Surgical-related outcomes have improved with increased experience, with an estimated learning curve of about 10–20 procedures. Laparoscopic SC is less costly than RASC, although the latter has lower costs than abdominal SC.

Conclusions

RASC is a safe and feasible procedure for POP; it allows the execution of complex surgical steps via minimally invasive surgery without medium- and long-term anatomic detriments. Further prospective studies are needed to confirm these findings.

Patient summary

We looked at the outcomes of robotic sacrocolpopexy for prolapse. We found that the use of robotic technology is safe and effective for the treatment of prolapse in women.     

Review of synthetic mesh-related complications in pelvic floor reconstructive surgery

There is significant risk of re-operation after pelvic reconstructive surgery. In an attempt to improve outcome, synthetic materials are increasingly being used to augment pelvic organ prolapse repair despite lack of strong evidence to support their routine use. The use of synthetic mesh to correct apical, anterior and posterior vaginal wall prolapse is not without complications. This review aims to evaluate the long-term complications of synthetic mesh in pelvic reconstructive surgery.     

Laparoscopic Management of Rectal Prolapse

Rectal prolapse can be a disabling condition for those affected. Treatment has historically been by transanal or abdominal approaches, with transanal approaches tending to have lower morbidity, and abdominal approaches having lower recurrence rates. With the advent of laparoscopy, many of the numerous described abdominal operations have been reported with a minimally invasive approach. Although few randomized data exist, laparoscopic operations appear to provide equal rectal fixation to open surgery, with less morbidity. Coexistent symtoms such as fecal incontinence and constipation must be evaluated before surgery, so that the operation can be tailored to the needs of the individual patient. Patients with severe constipation are often offered a concomitant sigmoid resection, although this does increase the potential for complications. Patients with incontinence, diarrhea, or otherwise normal function can be offered a rectopexy without resection. This study was presented at the ASCRS/SSAT symposium on minimally invasive management of rectal diseases, DDW, Los Angeles, May 2006     

A Review of the Current Status of Laparoscopic and Robot-assisted Sacrocolpopexy for Pelvic Organ Prolapse

Context

Abdominal sacrocolpopexy (ASC) represents the superior treatment for apical pelvic organ prolapse (POP) but is associated with increased length of stay, analgesic requirement, and cost compared with transvaginal procedures. Laparoscopic sacrocolpopexy (LSC) and robot-assisted sacrocolpopexy (RSC) may offer shorter postoperative recovery while maintaining equivalent rates of cure.

Objective

This review evaluates the literature on LSC and RSC for clinical outcomes and complications.

Evidence acquisition

A PubMed search of the available literature from 1966 to 2013 on LSC and RSC with a follow-up of at least 12 mo was performed. A total of 256 articles were screened, 69 articles selected, and outcomes from 26 presented. A review, not meta-analysis, was conducted due to the quality of the articles.

Evidence synthesis

LSC has become a mature technique with results from 11 patient series encompassing 1221 patients with a mean follow-up of 26 mo. Mean operative time was 124 min (range: 55–185) with a 3% (range: 0–11%) conversion rate. Objective cure was achieved in 91% of patients, with similar satisfaction rates (92%). Six patient series encompassing 363 patients treated with RSC with a mean follow-up of 28 mo have been reported. Mean operative time was 202 min (range: 161–288) with a 1% (range: 0–4%) conversion rate. Objective cure rate was 94%, with a 95% subjective success rate. Overall, early outcomes and complication rates for both LSC and RSC appeared comparable with open ASC.

Conclusions

LSC and RSC provide excellent short- to medium-term reconstructive outcomes for patients with POP. RSC is more expensive than LSC. Further studies are required to better understand the clinical performance of RSC versus LSC and confirm long-term efficacy.

Patient summary

Laparoscopic and robot-assisted sacrocolpopexy represent attractive minimally invasive alternatives to abdominal sacrocolpopexy. They may offer reduced patient morbidity but are associated with higher costs.