腹腔镜下阴道旁修补术治疗育龄期妇女阴道前壁膨出的临床疗效分析  

Clinical Efficacy of Laparoscopic Paravaginal Repair in the Treatment of Anterior Vaginal Prolapse in Women of Child-bearing Age

作　　者：池余刚[1] 雷丽[1] 刘禄斌[1] 杨玫[1] 文亚玲[1] 何萍[1] 

机构地区：[1]重庆市妇幼保健院妇科,重庆400020

出　　处：《华西医学》2015年第7期1246-1249,共4页West China Medical Journal

摘　　要：目的探讨腹腔镜下阴道旁修补术治疗育龄期妇女阴道前壁膨出的有效性和安全性。方法 2012年1月-2013年5月行腹腔镜下阴道旁修补术治疗育龄期妇女阴道前壁膨出21例（Ⅲ度5例,Ⅱ度15例,Ⅰ度1例）,腹腔镜下暴露耻骨和双侧Cooper韧带及盆侧壁盆筋膜腱弓,阴道穹隆角缝合于同侧坐骨棘,将阴道侧壁缝合于同侧白线。伴子宫脱垂者行腹腔镜下子宫骶骨固定术,伴张力性尿失禁者术中行膀胱颈Cooper韧带悬吊术（Burch）手术,伴阴道后壁脱垂者术中行阴道后壁修补术。术后患者无任何自觉症状定义为主观治愈;盆腔器官脱垂定量系统分期0度定义为客观治愈。结果同时行子宫骶骨固定术5例,行Burch手术3例,阴道后壁修补6例。手术时间110-225 min,平均155 min;术中出血量30-100 m L,平均60 m L;术中均无并发症发生;21例患者手术前后盆腔脏器脱垂评估指示点Aa点分别为（1.0±0.4）cm和（-3.0±0.8）cm,Ba点分别为（1.5±0.4）cm和（-3.0±0.5）cm,手术前后Aa、Ba点值比较,差异具有统计学意义（P〈0.01）;术后住院时间5-10 d,平均7 d;住院费用为7 000-11 000元,平均8 500元;1例术后2 d拔出尿管后出现尿道梗阻、排便困难,留置尿管7 d好转;21例术后随访10-18个月,平均15个月,19例主观治愈,20例客观治愈。结论腹腔镜下阴道旁修补术治疗育龄期妇女阴道旁缺陷所致的阴道前壁膨出手术创伤小、恢复快,是一种安全有效的治疗方法。Objective To evaluate the feasibility and efficacy of laparoscopic paravaginal repair（LPVR） for anterior vaginal prolapse in women of child-bearing age.Methods Totally,21 patients with anterior vaginal prolapse underwent laparoscopic extraperitoneal vaginal vault suspension between January 2012 and May 2013.Among the 21 patients,5 were in grade Ⅲ,15 in grade Ⅱ,and 1 in grade Ⅰ.Under laparoscope,the bilateral white lines and ischial spines were exposed,and then the angle of vaginal fornix was sutured to the ipsilateral ischial spine and the vaginal wall was sutured to the ipsilateral white line.Laparoscopic sacrocolpopexy or Burch or posterior vaginal wall repair was performed as well if necessary.The patients without any subjective symptom were defined as subjective cure and those whose pelvic organ prolapse quantification of anterior vaginal was zero degree were defined as objective cure.Results Laparoscopic sacrocolpopexy was performed in 5 patients,Burch in 3,and posterior vaginal wall repair alone in 6.The operation time ranged from 110 to 225 minutes with an average of 155 minutes,and the intraoperative blood loss ranged from 30 to 100 m L with an average of 60 m L.No intraoperative complication occurred.The marking point of pelvic organ prolapse quantitation Aa before and after operation was（ 1.0 ± 0.4） cm and（- 3.0 ± 0.8） cm,and Ba was（ 1.5 ± 0.4） cm and（- 3.0 ± 0.5） cm,and there were significant differences（ P 〈0.01）.The patients were discharged from hospital within 5 to 10 days averaging 7 days.The cost of hospitalization was 7 000 to 11 000 yuan,with an average of 8 500 yuan.One patient who felt obstruction of urethra and difficult urination was improved by keeping indwelling urinary catheter for7 days.Follow-up was achieved in 21 patients for 10 to 18 months with a mean of 15 months,and 19 of them had subjective cure and 20 of them objective cure.Conclusion LPVR can be successfully completed in anterior vaginal prolapse patients with paravaginal defect with less inju

关 键 词：腹腔镜 盆底功能障碍 阴道前壁膨出 阴道旁修补术 育龄期妇女 

分 类 号：R713[医药卫生—妇产科学]