阴道穹隆脱垂病人手术方式的选择

Choice of modus operandi for patients with vaginal vault prolapse

目的探讨适宜于阴道穹隆脱垂病人的手术方式。方法回顾性分析2008年7月至2010年12月本院26例阴道穹窿脱垂病人的一般资料、盆腔器官脱垂（POP）．Q分期、发病时间、需再次手术治疗时间、围手术期和随访情况。结果26例患者中因非女性盆底功能障碍（FPFD）行子宫全切术后穹隆脱垂者10例，其前次手术至此次发病时间（115．2±51．67）个月，距再次手术时间（142．8±59．04）个月；因FPFD行传统修复手术后穹隆脱垂者16例，其前次手术至此次发病时间（24．38±13．43）个月，距再次手术时间（62．13±44．51）个月；两组年龄及POP—Q分期比较差异无统计学意义（P〉0．05），后者较前者复发时间（t=6．75，P〈0．01）和需要再次手术治疗时间（t=3．97，P〈0．01）均明显提前。所有患者均由同一术者成功行Prolift全盆底重建术，手术时间（60．96±7．88）min，失血量（119．23±27．53）ml，无手术副损伤；术后随访治愈率100％，无网片侵蚀裸露发生及病例复发。结论传统手术治疗POP易复发，Prolift全盆底重建术是治疗POP适宜的手术方法，尤其适用于阴道穹窿脱垂的病人，该手术安全可行，复发率低，能更好地修补缺陷、实现结构重建和组织替代，有利于病人康复。

Objective To explore the perfect operation method for patients with vaginal vault pro- lapse. Methods Twenty six patients with vaginal vault prolapse who underwent transvaginal mesh repair by Prolift from January 2008 to June 2010 were analyzed retrospectively. Results The interval time between the first operation and this morbidity of ten patients who had underwent total hysterectomy for none FPFD （ ie： hysteromyoma et al） was （ 115.2 ± 51.67 ） months, but the interval of sixteen patients who had underwent traditional repair operation （ie ：transvaginal hysteromyoma and/or colporrhaphia anterior-posterior） for FPFD was （24. 38 ± 13.43 ） months, which was markedly shorter （ t = 6. 75, P 〈 0. 01 ）. The interval time between the first operation and the 2nd operation of the ten patients was （142. 8±59. 04） months, but that of the sixteen patients was （62. 13 ±44. 51） months, which was significantly shorter （ t =3.97, P 〈 0. 01 ）. Their age and POP-Q staging had no difference （ P 〉0. 05 ）. All operations were successfully performed by one gynecologist. The average operation time was （ 60. 96 ± 7.88 ） minutes, the average blood loss was （119. 23 ±27.53） ml, and there was no concomitant injury. All patients were followed up of 3 ±24 months. No vaginal erosion and prolapse recurrence happened, and the cure rate was 100%. Conclusions The Prolift system appeared to be a relatively safe and effective alternative to conventional surgeries for the treatment of vaginal vault prolapse. However, long-term follow-up still need to be performed.