腹腔镜下经腹膜外阴道旁修补术治疗阴道前壁脱垂9例报告

Laparoscopic Extraperitoneal Vaginal Vault Suspension for Anterior Vaginal Prolapse:Report of 9 Cases

目的探讨腹腔镜经腹膜外阴道旁修补术治疗阴道旁缺陷所致的阴道前壁脱垂的可行性及疗效。方法2010年7月～2011年10月行腹腔镜经腹膜外阴道旁修补术治疗阴道旁缺陷所致的阴道前壁脱垂9例(Ⅲ度4例,Ⅱ度1例,Ⅰ度4例;4例合并阴道后壁脱垂Ⅰ度),腹腔镜下腹膜外暴露双侧盆侧壁盆筋膜腱弓(白线)及坐骨棘,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。需行子宫全切及阴道壁修补术的患者同时行相应手术,但行阴道壁修补时不去除阴道壁。结果同时行阴式全子宫切除及阴道前后壁修补术4例,阴式全子宫切除1例,阴道前壁修补1例。手术时间75～310 min,平均177 min。除1例术中出血500 ml外,其余患者出血量中位数60 ml(5～280 ml)。术中均无并发症发生。3例术后出现臀部及下肢痛,除1例下肢痛持续2个月外,其余患者持续5～7 d后缓解。术后住院2～11 d,平均6 d。9例术后随访6～15个月,平均8个月,7例主观治愈及客观治愈。1例术后6个月感觉阴道肿物脱出,妇科检查为子宫脱垂Ⅰ度、阴道前壁脱垂Ⅰ度;1例术后1年感觉阴道肿物脱出,妇科检查为阴道前壁脱垂Ⅰ度。所有患者术后阴道深度均>7 cm。结论腹腔镜经腹膜外阴道旁修补术治疗阴道旁缺陷所致的阴道前壁脱垂安全、可行,能保留阴道的原有深度,近期疗效好。

Objective To evaluate the feasibility and efficacy of laparoscopic extraperitoneal vaginal vault suspension for anterior vaginal prolapse. Methods Totally 9 patients with anterior vaginal prolapse underwent laparoscopic extraperitoneal vaginal vault suspension between July 2010 and October 2011 in our hospital. Among the 9 patients, 4 were in grade III , 1 in grade ]I , and 4 in grade I ; 4 of the patients were complicated with grade I posterior vaginal prolapse. Under a laparoscope, the bilateral white lines and ischial spines were exposed, then the angle of the vaginal fornix was sutured to the ipsilateral ischial spine, and the vaginal wall was sutured to the ipsilateral white line. Radial hysterectomy and/or vaginal wall repair （without reseeting the vaginal wall） was performed as well if necessary. Results Transvaginal radical hysterectomy and posterior and anterior vaginal wall repair were performed on 4 patients, and transvaginal radical hysterectomy alone in 1, and anterior vaginal wall repair alone in 1. The operation time ranged from 75 to 310 rain with a mean of 177 rain, and the intraoperative blood loss was 60 ml in medium （5 -280 ml） , expect for one patient who had intraoperative blood loss of 500 ml. No intraoperative complication occurred. After the procedure, three patients developed pain in the hips or lower limbs, which lasted for 5 to 7 days （ except for one patient who had suffered the pain in the lower limbs for 2 months）. The patients were discharged from hospital in 2 to 11 days postoperation （ mean, 6 days）. Follow-up was achieved in 9 patients for 6 to 15 months with a mean of 8 months, 7 of them had subjective and objective cure; in the other two patients, grade I anterior vaginal prolapse complicated with uterine prolapse was detected in 6 months in one patient, and grade I anterior vaginal prolapse was diagnosed in the other in one year. The postoperative depth of the vagina was 〉 7 cm in all the cases. Conclusions Laparoscopie extraperitoneal vaginal vault suspension is feasible and effective for the anterior vaginal prolapse caused by paravaginal defect, with the depth of the vagina preserved. The short-term outcome of the procedure is good.