Chinese Medical E-ournals Database

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2022, Vol. 18 ›› Issue (01): 80 -86. doi: 10.3877/cma.j.issn.1673-5250.2022.01.011

Original Article

Clinical analysis of modified anterior and posterior vaginal wall joint repair

Yijun Yang1,1, Suwan Qi2,2, Can Shi1,1, Yi Jiang3,3, Ting Wang1,1, Yingchun Gao1,1,()   

  • Received:2021-10-08 Revised:2021-11-20 Published:2022-02-01
  • Corresponding author: Yingchun Gao
  • Supported by:
    National Natural Science Foundation of China(81702566); Project of Jiangsu Maternal and Child Health Association(FYX202117); Huai′an Health Research Project(HAWJ201903); Huai′an Natural Sciences Research Projects(HAB202105); Science and Technology Development Fund of Nanjing Medical University(NMUB2019347); Development Funds of the Affiliated Hospital of Xuzhou Medical University(XYFM2021035); Education Research Projects of the Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University(hyyjy2021011)
Objective

To explore clinical effect of modified anterior and posterior vaginal wall joint repair in treatment of pelvic organ prolapse (POP).

Methods

From January 2017 to January 2021, a total of 120 POP patients who received surgical treatment in the Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University were chosen as research subjects. According to surgical methods, they were divided into observation group (n=60, patients received modified vaginal anterior and posterior wall joint repair) and control group (n=60, patients received laparoscopic hysterectomy with bilateral adnexectomy plus traditional anterior and posterior vaginal wall repair). The general clinical data, intraoperative and postoperative conditions of patients were statistically compared between two groups by independent-samples t test and chi-square test. This study was approved by the Medical Ethics Committee of the Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University (Approval No. YX-P-2020-023-01), and all patients signed the informed consents.

Results

① There were no significant differences between two groups of POP patients in age, body mass index (BMI), parity, proportion of menopause and POP prolapse degree (P>0.05). ② The operating duration, volume of intraoperative bleeding, total average length of hospital stay, average postoperative length of hospital stay and cost of hospitalization in observation group were (88.0±30.6) min, (24.7±36.0) mL, (7.3±2.1) d, (4.6±1.4) d and (10 727±1 812) yuan, respectively, which were shorter or less than those of (118.0±33.4) min, (56.7±43.8) mL, (9.8±2.3) d, (6.4±1.6) d and (26 318±3 890) yuan, respectively in control group, and the differences were statistically significant (t=5.130, 4.372, 6.218, 6.558, 28.138; all P<0.001). There was no significant difference in constituent ratio of 3, 6, 12 months′ recurrence rate of POP after surgery between two groups (P>0.05).

Conclusions

On the basis of no increasing in postoperative recurrence rate of POP, the modified vaginal anterior and posterior wall joint repair could not only shorten operation duration and reduce volumes of intraoperative bleeding, but also shorten the length of hospital stay and reduce cost of hospitalization, which is easy to operate and suitable for popularization and application.

图1 1例POP-Q Ⅲ度患者(58岁)新式阴道前、后壁联合修补术主要手术步骤的术中照片图与示意图[图1A、1I:纵行切开阴道前壁黏膜;图1B、1J:将阴道前壁从膀胱筋膜分离;图1C、1K:充分分离阴道膀胱间隙,上端位于阴道横沟水平、2侧达耻骨降支水平、下端位于膀胱底宫颈附着处稍下方;图1D、1L:"烧杯形"切开阴道后壁黏膜,使下1/3黏膜呈正三角形,上2/3黏膜呈宽约1.0 cm的长方形,分离阴道后壁黏膜直至穹窿部位;图1E、1M:上推膀胱,采用7#丝线于耻骨降支水平呈"U"型间断缝合双侧阴道壁筋膜组织,使膀胱完全位于阴道筋膜的上方;图1F、1N:采用2-0可吸收线连续兜底自阴道纵行切口顶端呈"U"型全层缝合阴道壁直至切口的下缘(示意图中红色实线及虚线表示缝线);图1G、1O:修剪缝合缘处多余阴道壁组织后,采用2-0可吸收线连续锁边缝合阴道前壁黏膜;图1H、1P:采用2-0可吸收线连续锁边缝合阴道后壁黏膜]注:图1A~1H为照片图,图1I~1P为示意图。POP-Q为盆腔脏器脱垂定量
表1 2组POP患者一般临床资料比较
表2 2组POP患者术中及术后情况比较
[1]
中华医学会妇产科学分会妇科盆底学组. 盆腔器官脱垂的中国诊治指南(2020年版)[J]. 中华妇产科杂志2020, 55(5): 300-306. DOI: 10.3760/cma.j.cn112141-20200106-00016.
[2]
Brincat CA. Pelvic organ prolapse: reconsidering treatment, innovation, and failure[J]. JAMA, 2019, 322(11): 1047-1048. DOI: 10.1001/jama.2019.12245.
[3]
Nager CW, Visco AG, Richter HE, et al. Effect of vaginal mesh hysteropexy vs vaginal hysterectomy with uterosacral ligament suspension on treatment failure in women with uterovaginal prolapse: a randomized clinical trial[J]. JAMA, 2019, 322(11): 1054-1065. DOI: 10.1001/jama.2019.12812.
[4]
李棪, 王楠, 付晓宇, 等. 改良阴道前后壁联合修补术治疗盆腔器官脱垂的疗效观察[J]. 解放军医学院学报2018, 39(6): 491-493, 497. DOI: 10.3969/j.issn.2095-5227.2018.06.009.
[5]
宋磊, 付晓宇, 李棪. 新式经阴道盆腔器官脱垂手术临床研究[J]. 中国实用妇科与产科杂志2018, 34(11): 1267-1270. DOI: 10.19538/j.fk2018110119.
[6]
Bump RC, Mattiasson A, K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction[J]. Am J Obstet Gynecol, 1996, 175(1): 10-17. DOI: 10.1016/s0002-9378(96)70243-0.
[7]
於莉英, 张桂宝. 阴道前壁"斜拉桥"式修补术与传统阴道前壁修补术治疗阴道前壁膨出的临床效果比较[J]. 中国微创外科杂志2013, 13(3): 262-265. DOI: 10.3969/j.issn.1009-6604.2013.03.022.
[8]
Petros PE. Vault prolapseⅡ: restoration of dynamic vaginal supports by infracoccygeal sacropexy, an axial day-case vaginal procedure[J]. Int Urogynecol J Pelvic Floor Dysfunct, 2001, 12(5): 296-303. DOI: 10.1007/pl00004039.
[9]
DeLancey JO. Anatomy and biomechanics of genital prolapse[J]. Clin Obstet Gynecol, 1993, 36(4): 897-909. DOI: 10.1097/00003081-199312000-00015.
[10]
朱兰, 朗景和, 宋岩峰. 第一届全国女性尿失禁与盆底功能障碍学术会纪要[J]. 中华妇产科杂志2004, 39(10): 652-654. DOI: 10.3760/j.issn:0529-567X.2004.10.002.
[11]
Pelvic organ prolapse: ACOG practice bulletin, Number 214[J]. Obstet Gynecol, 2019, 134(5): e126-e142. DOI: 10.1097/AOG.0000000000003519.
[12]
Serati M, Laganà AS, Casarin J, et al. Laparoscopic duplication of the uterosacral ligaments following hysterectomy for stage Ⅲ-Ⅳ apical pelvic organ prolapse[J]. Updates Surg, 2020, 72(1): 199-204. DOI: 10.1007/s13304-019-00690-9.
[13]
Ko KJ, Lee KS. Current surgical management of pelvic organ prolapse: strategies for the improvement of surgical outcomes[J]. Investig Clin Urol, 2019, 60(6): 413-424. DOI: 10.4111/icu.2019.60.6.413.
[14]
Kieserman-Shmokler C, Swenson CW, Chen L, et al. From molecular to macro: the key role of the apical ligaments in uterovaginal support[J]. Am J Obstet Gynecol, 2020, 222(5): 427-436. DOI: 10.1016/j.ajog.2019.10.006.
[15]
宋岩峰. 如何理解经阴道植入网片手术的专家共识[J]. 中国实用妇科与产科杂志2020, 36(10): 924-927. DOI: 10.19538/j.fk2020100104.
[16]
Korbly NB, Kassis NC, Good MM, et al. Patient preferences for uterine preservation and hysterectomy in women with pelvic organ prolapse[J]. Am J Obstet Gynecol, 2013, 209(5): 470. e1-470. e4706. DOI: 10.1016/j.ajog.2013.08.003.
[17]
Dietz HP. Prolapse worsens with age, doesn′t it?[J]. Aust N Z J Obstet Gynaecol, 2008, 48(6): 587-591. DOI: 10.1111/j.1479-828X.2008.00904.x.
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