腹腔镜髂耻韧带悬吊术在治疗盆腔器官脱垂中的研究进展

在中老年女性日常生活中，盆腔器官脱垂（pelvic organ prolapse，POP）的负面影响越来越严重，其发病率也在逐年增高。由中盆腔缺陷导致的子宫或穹窿的脱垂在POP中并不少见，其手术后复发率与术中修复是否达到标准密切相关。腹腔镜手术及植入性网片的应用，使手术更趋向微创及生理解剖结构重建，降低了术后复发率及并发症发生率。目前，腹腔镜阴道骶骨固定术（LSC）或腹腔镜子宫骶骨固定术（LSH）是中盆腔脱垂治疗的金标准术式，但对于盆腔空间狭小（肥胖或者粘连等导致）的患者此手术实施起来比较困难，排便问题（尤其是便秘）是最常见的并发症。许多外科医生改进了该术式，将网片固定在骶岬顶端，但此部位的固定导致腹壁方向发生改变。而应用腹腔镜髂耻韧带悬吊术的术后主观满意度高、复发率极低，能够恢复盆底生理解剖结构，具有较好的临床效果。

Advances of Laparoscopic Pectopexy in the Treatment of Pelvic Organ Prolapse

In the daily life of middle and old aged women, the negative impact of pelvic organ prolapse (POP) is worse and worse, and its incidence is also increasing year by year. Prolapse of uterus or vault caused by pelvic defect is not uncommon in POP. The recurrence rate after operation is closely related to whether the repair is up to the standard. The application of laparoscopy surgery and implantable mesh makes the operation more minimally invasive and biologically reconstructed, reducing the recurrence rate and the incidence of complications. At present, laparoscopic sacrocolpopexy (LSC) or laparoscopic sacrohysteropexy (LSH) has become the gold standard in the treatment of pelvic prolapse, but it is difficult to perform in patients with narrow pelvic space (caused by obesity or adhesions, etc.) and defecation problems (especially constipation) are the most common complications. So many surgeons have improved the procedure by fixing the mesh to the top of the sacral promontory. However, the fixation of this site led to a change in the direction of the abdominal wall. Laparoscopic pectopexy has high subjective satisfaction and low recurrence rate. It can restore the physiological and anatomical structure of the pelvic floor and has good clinical effect.