阴道后壁无张力悬吊加桥式网片修补治疗阴道穹窿脱垂

目的探讨采用阴道后壁无张力悬吊术加桥式网片治疗阴道穹窿脱垂的临床价值。方法通过在会阴和阴道后穹窿植入聚丙烯吊带，达到重建子宫骶韧带并将阴道顶端固定在正常解剖位置，分别在阴道前后壁做个“桥”并置入网片，加强阴道前、后壁力量，降低术后膨出的复发率。结果15例患者中，5例既往曾行阴式手术，10例无阴式手术史，悬吊后脱垂全部治愈，平均手术时间55min，平均出血量150ml。平均随访7个月，均未出现阴道明显缩短，无性交困难。有1例补片钻出阴道壁1．5cm，1例出现阴道血肿。结论阴道后壁悬吊术是在吊带周围发生纤维化反应，加固并代替松弛的韧带，是治疗阴道穹窿脱垂创伤最小的手术。结合在阴道前、后壁筋膜上添加补片插入加固，该方法加强了宫骶韧带，使盆底膨出有了简单、有效的治疗方法，且术后不影响阴道的长度，降低了复发的可能。

Treating prolapse of vaginal vault by posterior intra-vaginal slingplasty plus bridge-like mesh

Objective To appraise the clinical value of treating prolapse of vaginal vault by posterior intra-vaginal slingplasty(IVS) plus bridge-like mesh. Methods To place the polypropelene tape through perineum and vaginal vault for fixing the apicalvagine back to normal anatomical position by reconstruction of utero-sacral ligament. Bridge-like meshes were placed in the anterior and posterior vaginal wall for reinforcement so as to decrease the recurrence rate of postoperative prolapse. Results All 15 cases, five with vaginal operation and 10 without such history, were cured. The mean operation duration was 55 min and mean bleeding volume was 150 ml. Ob-vious shortening of vagina and dyspareunia were not found during follow up, but one patient had mild mesh erosion and another developed vaginal hematoma. Conclusions The tape of IVS reinforces the loosened uterosacral ligament through reactive fibrosis. It is a mini-ivasive, simple and effective when combined with mesh in treating prolapse of vaginal vault. IVS also does not affect the length of vagina thus reduces the probability of recurrence.