高位骶韧带悬吊联合阴道前后壁网片加固术临床疗效

目的:研究经阴道高位骶韧带阴道穹隆悬吊联合阴道前后壁网片加固对盆腔器官脱垂患者盆底器官解剖和功能恢复情况。方法:从2005年1月至2006年4月期间,在我院及省内十余家医院,对98例子宫脱垂及阴道前后壁膨出患者知情同意下施行本手术。术后每3月随访1次,随访要求接受妇科检查,手术前后器官脱垂按照盆腔器官脱垂量化分期(POP-Q)分度。通过询问有无阴道脱出物、坠胀感及大小便和性生活不适来了解盆底器官功能恢复情况。结果:随访12-27月,平均20月,穹窿及阴道后壁复发率为0%,膀胱膨出复发率为3%。1例直肠损伤,无输尿管损伤和梗阻。3例网片侵蚀。术后大小便、性功能较术前改善。结论:经阴道高位骶韧带悬吊阴道穹隆悬吊联合阴道前后壁网片加固对盆腔器官脱垂能实现盆底重建,达到解剖复位及大小便、性功能改善,短期效果满意。长期效果有待进一步随访。网片侵蚀是主要并发症。

Clinical Study of 98 Cases of High Uterosacral Ligaments Suspension of Vaginal Vault and Anterior and Posterior Vaginal Repair with Mesh by Vaginal Route

Objective:To study the functional and anatomic outcomes of women who underwent vaginal repair of uterine and vaginal vault prolapse with the use of high suspension of the vaginal vault to the uterosacral ligaments and vaginal repair with mesh.Methods:Ninety-eight women with uterine and vaginal vault prolapse with vaginal prolapse were treated from January,2005 to April,2006 with uterosacral ligaments fixation to the vaginal culff and vaginal repair using mesh by the vaginal route.Outcome measures included POP-Q examination and function inquiry of urine,bowel and sex.Results:After a median follow-up of 20 months(range 3-27 months),97% of patients had resolution of prolapse.One case had rectal bowel injury,and no ureteral injury occurred.Three cases of mesh erosion occurred.There were significant improvements in symptoms of bulging and pressure,voiding dysfunction of urine and bowel and sexual dysfunction.Conclusion:Through vaginal repair of uterine and vaginal vault prolapse with the use of suspension of the vaginal vault to the uterosacral ligaments and repair of vagina prolapse with mesh would seems to provide an anatomic repair with good functional improvement in patients with pelvic organ prolapse.