改良的经后路阴道壁悬吊术在盆底重建中的应用

目的 探讨应用改良的经后路阴道壁悬吊(PVWH)术治疗盆腔器官脱垂,同时保留子宫,及进行盆底重建的可行性和有效性。方法对32例有不同缺陷的盆腔器官膨出患者进行改良的PVWH术。应用聚丙烯网片悬吊双侧骶棘韧带,将脱垂的子宫复位;经阴道放置悬吊带,以加固子宫骶骨韧带;在应用聚丙烯网片形成新的阴道直肠筋膜的同时,加固肛提肌板,完成中后盆底重建。根据国际尿控协会制定的盆腔器官脱垂定量(POP-Q)分度法,评价手术效果。结果改良的PVWH术的手术时间平均为55min,出血量平均为150ml。根据POP-Q分度法,32例患者的子宫脱垂全部得到纠正;平均随访7个月,均未出现阴道扭曲、缩短,无性生活障碍。除1例患者出现宫颈延长外,其余无复发;各种症状改善率≥50％。结论改良的．PVWH术,对子宫脱垂患者在保留子宫的同时行中后盆底重建的短期疗效稳定,长期疗效尚有待进一步观察。

Clinical application of a modified posterior vaginal wall hammock in female pelvic floor reconstruction

Objective To explore the feasibility and effectiveness of a modified posterior vaginal wall hammock(PVWH) in the treatment of female pelvic organ prolapse without removal of uterus. Methods(Thirty-two) patients with different defects of pelvic organ prolapse underwent a modified PVWH. The procedures included restoring the position of prolapsed uterus by suturing polypropylene mesh to bilateral sacro-spinous ligaments, strengthening utero-sacral ligament by intra-vaginal slingplasty(Tyco Healthcare Group), forming a new recto-vaginal fascia and strengthening levator ani muscle. Results The average operating time was 55 minutes and hemorrhage was 150 ml respectively. Recovery of uterine prolapse was achieved in all cases.After an average follow up of seven months,no vagina distortion, shortening and dyspareunia were observed.One patient had uterine cervix elongation three months after operation. The relieving rate of subjective symptoms was more than 50%. Conclusions Female uterine prolapse could be cured by the modified PVWH and the uterus could be successfully reserved during pelvic floor reconstruction with promising short-term results. More clinical trials are needed to evaluate its effectiveness, safety and long-term outcome.