骶主韧带复合体、耻骨阴道肌交叉缝合术治疗子宫脱垂及阴道前壁膨出36例临床分析(1)
[摘要]目的 探讨骶主韧带复合体、耻骨阴道肌交叉缝合术治疗子宫脱垂及阴道前壁膨出的疗效。方法 选取2012年8月～2014年12月本院收治的36例子宫脱垂合并阴道前后壁膨出患者作为研究对象，行阴式全子宫切除+骶主韧带复合体、耻骨阴道肌交叉缝合(+阴道后壁修补术+会阴裂伤修补术)，术后对患者的主客观疗效进行分析，包括围术期情况及并发症。结果 36例患者均顺利完成手术，POP-Q各指示点位置术后均较术前明显上升，达到了解剖学复位(P<0.01)，所有POP-Q指示点均较术前明显改善。34例POP-Q分度为0度，仅2例POP-Q分度为Ⅰ度(术前POP-Q评分Ⅳ度)。客观治愈率为100%，主观满意率为100%。结论 骶主韧带复合体、耻骨阴道肌交叉缝合术利用自身组织治疗前盆腔缺陷效果肯定，手术操作简单，医疗费用低，复发率低，可操作性强。
[关键词]骶主韧带复合体；耻骨阴道肌；前盆腔功能障碍(阴道前壁膨出)
[中图分类号] R711.74 [文献标识码] A [文章编号] 1674-4721(2016)08(a)-0126-04
[Abstract]Objective To explore the curative effectiveness of main sacral ligament complex and pubovaginalis cross suture in the treatment of uterine and anterior vaginal wall prolapse.Methods Altogether 36 cases of the uterine prolapse complicated with the anterior vaginal wall bulge in our hospital from August 2012 to December 2014 were selected as the research group ，which were treated with vaginal hysterectomy combined with main sacral ligament complex and pubovaginalis cross suture (combined with repair of posterior vaginal wall and repair of perineal laceration).Post-operational subjective and objective curative effectiveness of patients was analyzed，including peri-operative conditions and complications.Results Surgeries of 36 cases of patients were successfully completed.Post-operative POP-Q scores in each position increased significantly compared with the pre-operative one and reached anatomical reduction (P<0.01).All POP-Q scores in indication sites were significantly improved compared with the pre-operative one.Among all the cases，34 cases of POP-Q scores were at degree 0，only 2 cases of POP-Q scores were at degree Ⅰ (pre-operative POP-Q score：Ⅳ degree).The objective curative rate was 100%，and the subjective satisfaction rate was 100%.Conclusion The main sacral ligament complex and pubovaginalis cross suture demonstrates great effectiveness in the use of self-organization in the treatment of anterior pelvic defects and its easy-to-operate features with strong practicality，low medical expenses and recurrence rate.
[Key words]Main sacral ligament complex；Pubovaginalis；Anterior pelvic dysfunction (anterior vaginal wall prolapsed)
女性盆底支持组织因退化、创伤等因素导致其支持薄弱，从而发生盆底功能障碍(pelvic floor dysfunction，PFD)[1]。PFD主要包括盆腔脏器脱垂(pelvic organ prolapse，POP)及压力性尿失禁(stress urinary incontinence，SUI)[2-3]。阴道前壁膨出属于前盆腔脏器脱垂，其中重度膨出并伴有子宫脱垂的患者行子宫全切术及阴道前壁修补术后的再次复发，是临床上一个非常棘手的问题。传统的阴式子宫全切及阴道修补术后，阴道前后壁及阴道穹隆膨出复发率达2%～45%[4]。本研究采用骶主韧带复合体、耻骨阴道肌交叉缝合术治疗子宫脱垂及阴道前壁膨出，取得了良好的效果，实现了较为完善的盆底修复和重建，提高了患者生活质量。 (陈苑红 闫彩霞 冯书梅 陈少慧 李海静)
[关键词]骶主韧带复合体；耻骨阴道肌；前盆腔功能障碍(阴道前壁膨出)
[中图分类号] R711.74 [文献标识码] A [文章编号] 1674-4721(2016)08(a)-0126-04
[Abstract]Objective To explore the curative effectiveness of main sacral ligament complex and pubovaginalis cross suture in the treatment of uterine and anterior vaginal wall prolapse.Methods Altogether 36 cases of the uterine prolapse complicated with the anterior vaginal wall bulge in our hospital from August 2012 to December 2014 were selected as the research group ，which were treated with vaginal hysterectomy combined with main sacral ligament complex and pubovaginalis cross suture (combined with repair of posterior vaginal wall and repair of perineal laceration).Post-operational subjective and objective curative effectiveness of patients was analyzed，including peri-operative conditions and complications.Results Surgeries of 36 cases of patients were successfully completed.Post-operative POP-Q scores in each position increased significantly compared with the pre-operative one and reached anatomical reduction (P<0.01).All POP-Q scores in indication sites were significantly improved compared with the pre-operative one.Among all the cases，34 cases of POP-Q scores were at degree 0，only 2 cases of POP-Q scores were at degree Ⅰ (pre-operative POP-Q score：Ⅳ degree).The objective curative rate was 100%，and the subjective satisfaction rate was 100%.Conclusion The main sacral ligament complex and pubovaginalis cross suture demonstrates great effectiveness in the use of self-organization in the treatment of anterior pelvic defects and its easy-to-operate features with strong practicality，low medical expenses and recurrence rate.
[Key words]Main sacral ligament complex；Pubovaginalis；Anterior pelvic dysfunction (anterior vaginal wall prolapsed)
女性盆底支持组织因退化、创伤等因素导致其支持薄弱，从而发生盆底功能障碍(pelvic floor dysfunction，PFD)[1]。PFD主要包括盆腔脏器脱垂(pelvic organ prolapse，POP)及压力性尿失禁(stress urinary incontinence，SUI)[2-3]。阴道前壁膨出属于前盆腔脏器脱垂，其中重度膨出并伴有子宫脱垂的患者行子宫全切术及阴道前壁修补术后的再次复发，是临床上一个非常棘手的问题。传统的阴式子宫全切及阴道修补术后，阴道前后壁及阴道穹隆膨出复发率达2%～45%[4]。本研究采用骶主韧带复合体、耻骨阴道肌交叉缝合术治疗子宫脱垂及阴道前壁膨出，取得了良好的效果，实现了较为完善的盆底修复和重建，提高了患者生活质量。 (陈苑红 闫彩霞 冯书梅 陈少慧 李海静)