改良阴道旁修补术在盆底重建中的作用

Clinical observation of effect of modified vaginal paravaginal repair on pelvic floor reconstruction in 52 cases

目的 探讨改良阴道旁修补术治疗阴道前壁及膀胱膨出的有效性和安全性.方法 我院自2007年1月至2009年8月采用改良阴道旁修补术治疗52例阴道前壁及膀胱膨出的患者,其中6例患者既往曾行阴道前壁修补术.术后1、3、6、12、24个月定期随访,对手术效果进行主观及客观评价.客观治愈标准定义为阴道残端位于坐骨棘水平.结果 52例患者盆腔器官脱垂定量系统（POP-Q）分期Ⅱ期30例,Ⅲ期17例,Ⅳ期5例.所有患者改良阴道旁修补术均获成功.手术时间为45～110 min,平均（65±18）min,出血量50～200 ml,平均（95±27）ml,无其他手术并发症.随访3～24个月,平均（10.1±3.1）个月,复发6例（11.5%） 其中5例为POP-Q分期Ⅰ期,1例POP-Q分期Ⅲ期.结论 改良阴道旁修补术在盆底重建中短期治疗效果稳定,较应用补片手术方法简单,并发症少.

Objective To explore the efficacy and safety of modified vaginal paravaginal repair （VPVR） in treatment of symptomatic paravaginal defect cystocele（PDCC）. Methods This study was an observational case series of 52 consecutive women in Beijing hospital from January 2007 to August 2009, with symptomatic paravaginal defect cystocele. Among them, 6 patients had anterior wall colporrhaphy. Preoperative and postoperative pelvic evaluations were performed with the POP-Q system. All the cases underwent vaginal approach to paravaginal repair, 49 cases underwent vaginal hysterectomy simultaneously. Patients were followed up for 1 to 24 months. Criteria for objective cure were defined as the anterior vaginal walls at grade 0 and firmly apposing to the lateral pelvic sidewalls.Results Of the 52 patients, 30 had grade Ⅱ , 17 had grade Ⅲ, and 5 had grade Ⅳ paravaginal defect cystocele. In all patients the VPVR was performed successfully. No complication happened during and after operation. The average operation time was （65 ±18） min （45-110 min） and estimated blood loss was （95 ± 27） ml （50-200 ml）. Patients were followed up postoperatively for 3 to 24months, with a mean of （10. 1±3.1） months. The PDCC recurred in 6 cases, 5 patients had grade Ⅰcystocele and 1 had grade Ⅲ cystocele. Conclusions The vaginal approach to the correction of paravaginal defect cystocele is highly effective in our population.