改良经阴道骶骨阴道固定术治疗中盆腔脏器脱垂的临床研究

doi:10.3877/cma.j.issn.1673-5250.2013.02.010

目的

探讨改良经阴道骶骨阴道固定术治疗中盆腔脏器脱垂的临床价值。

方法

选择2011年11月至2012年1月，子宫切除术后及需行子宫切除术的中盆腔脏器脱垂患者5例为研究对象，并对其手术时间，术中出血量，术中并发症，术后病率，术后排尿情况，排便时间，住院时间及术前、术后C点位置恢复情况进行分析(本研究遵循的程序符合本院人体试验委员会制定的伦理学标准，得到该委员会批注，征得受试对象的知情同意并与之签署临床研究知情同意书)。

结果

5例患者手术均成功，平均手术时间为(136.2±34.4)min，平均术中出血量为(55.3±27.8)mL，术中无一例发生相关并发症。术后第1天晨起拔除尿管后均自解小便顺利；1例患者同时行腹腔镜下全子宫切除＋双附件切除术，术后第2天发生不全肠梗阻，予对症治疗，术后12 d肠功能完全恢复出院。另外4例患者于术后48 h内恢复排气，平均术后住院时间为5.4 d。术后即刻、术后8周随访时C点测量值均在－6 cm以上，客观治愈率为100%，亦无一例患者发生阴道前后、壁膨出。

结论

改良经阴道骶骨阴道固定术为中盆腔脏器脱垂的手术，具有利用人体自然通道、阴道轴向不发生改变、术中出血量少、术后创伤小及恢复快等优势。

关键词: 中盆腔脏器脱垂, 经阴道, 骶骨阴道固定术

Objective

To discuss the clinic value of modified transvaginal sacrocolpopexy for the middle compartment pelvic organ prolapse.

Methods

Five patients with middle compartment pelvic organ prolapse were treated by transvaginal sacrocolpopexy between November 2011 to January 2012 in Yantai Yuhuangding Hospital. And the following items were observed, the duration of operation, bleeding loss, complications, postoperative morbidity, urination after operation, defecation after operation, hospitalization time, and the position of C point. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Yantai Yuhuangding Hospital. Informed consent was obtained from all participates.

Results

The operations in five patients were smoothly completed. The average operative time was (136.2±34.4) min, average blood loss was (55.3±27.8) mL during operation, there was no complications. All the patients could urinate by themselves in one day after operation. One patient had incomplete intestinal obstruction in two days after operation, but she recovered in twelve days. Other four patients had the normal function of intestine in two days after operation. The hospitalization time after operation were 5.4 d. The measurement of C point for all patients in immediate post-operation and 8 weeks after operation were above -6 cm. The objective cure rate was 100%.

Conclusions

Transvaginal sacrocolpopexy can use the body's natural channel, restore the normal anatomy without changing the vaginal axial. The advantages of transvaginal sacrocolpopexy includes less blood loss, less trauma, quiker discovery.

Key words: middle compartment pelvic organ prolapse, transvaginal, sacrocolpopexy

表1 5例患者的一般临床资料

Table 1 The general clinical data of five patients

患者编号(No.)	年龄(岁)	BMI(kg/m²)	孕次(次)	产次(次)	绝经年龄(岁)	C点测量值(cm)	POP-Q分度(°)	合并其他盆底疾病	合并其他妇科疾病
1	48	26.0	4	3	－	＋6.0	Ⅳ	阴道前壁脱垂(Ⅱ°)	多发性子宫肌瘤
2	68	23.3	2	2	50	＋3.0	Ⅲ	无	无
3	65	25.4	2	2	52	＋5.0	Ⅲ	SUI	子宫内膜息肉样增生
4	70	21.7	5	4	51	＋4.5	Ⅲ	阴道前壁脱垂(Ⅰ°)	无
5	72	28.6	5	5	53	＋6.5	Ⅳ	阴道前壁脱垂(Ⅲ°)	双侧卵巢囊肿

表1 5例患者的一般临床资料

Table 1 The general clinical data of five patients

患者编号(No.)	年龄(岁)	BMI(kg/m²)	孕次(次)	产次(次)	绝经年龄(岁)	C点测量值(cm)	POP-Q分度(°)	合并其他盆底疾病	合并其他妇科疾病
1	48	26.0	4	3	－	＋6.0	Ⅳ	阴道前壁脱垂(Ⅱ°)	多发性子宫肌瘤
2	68	23.3	2	2	50	＋3.0	Ⅲ	无	无
3	65	25.4	2	2	52	＋5.0	Ⅲ	SUI	子宫内膜息肉样增生
4	70	21.7	5	4	51	＋4.5	Ⅲ	阴道前壁脱垂(Ⅰ°)	无
5	72	28.6	5	5	53	＋6.5	Ⅳ	阴道前壁脱垂(Ⅲ°)	双侧卵巢囊肿

图1 暴露并剪开直肠右侧前腹膜

Figure 1 Expose and cut the anterior peritoneum in the right of the rectum

图2 剪开直肠右侧前腹膜至直肠中横襞的腹膜凹陷

Figure 2 Cut the anterior peritoneum in the right of the rectum to the peritoneal pitting of the middle transverse fold in the rectum

图3 钝性分离直肠、暴露骶骨

Figure 3 Blunt dissect the rectum，expose the sacrum

图4 缝合骶2前纵韧带2针

Figure 4 Suture the anterior longitudinal ligament of S2 for two stitches

图5 缝合骶2前纵韧带后

Figure 5 After suture the anterior longitudinal ligament of S2

图6 关闭后腹膜，滑线保留在腹膜外隙

Figure 6 Close the posterior peritoneum，slip sutures remained in the extraperitoneal gap

图7 关闭盆底腹膜，将所有切除子宫的断端缝至腹膜外、阴道壁内

Figure 7 Close the pelvic peritoneum，suture all the hysterectomy stumps to extraperitonium and in the vaginal wall

图8 缝至前纵韧带的滑线分别缝在同侧阴道壁侧方的韧带上，并留线至阴道切口外

Figure 8 The slip sutures of sutured to the anterior longitudinal ligament respectively sutured to the ligment outside the ipsilateral vaginal wall，and remain the sutures outside the vaginal incision

表2 5例患者术前、术后即刻及术后8周C点测量值(cm)

Table 2 C point measurement value of pre- and post-operation and eight weeks after the operation(cm)

患者编号(No.)	术前	术后即刻	术后8周
1	＋6.0	－7.0	－7.0
2	＋3.0	－6.5	－6.5
3	＋5.0	－7.0	－7.0
4	＋4.5	－6.5	－6.5
5	＋6.5	－7.5	－7.0
平均值(±s)	＋5.0±1.4	－6.9±0.4	－6.8±0.3

表2 5例患者术前、术后即刻及术后8周C点测量值(cm)

Table 2 C point measurement value of pre- and post-operation and eight weeks after the operation(cm)

患者编号(No.)	术前	术后即刻	术后8周
1	＋6.0	－7.0	－7.0
2	＋3.0	－6.5	－6.5
3	＋5.0	－7.0	－7.0
4	＋4.5	－6.5	－6.5
5	＋6.5	－7.5	－7.0
平均值(±s)	＋5.0±1.4	－6.9±0.4	－6.8±0.3

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Clinic Study of Modified Transvaginal Sacrocolpopexy for Middle Compartment Pelvic Organ Prolapse

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Clinic Study of Modified Transvaginal Sacrocolpopexy for Middle Compartment Pelvic Organ Prolapse