阴道前壁“斜拉桥”式修补术与传统阴道前壁修补术治疗阴道前壁膨出的临床效果比较

Comparison between Anterior Vaginal Wall Repair of Cable-stayed Bridge Type and Traditional Anterior Vaginal Wall Repair for Anterior Vaginal Wall Prolapse

目的比较阴道前壁"斜拉桥"式修补术与传统阴道前壁修补术治疗阴道前壁膨出的临床效果。方法 2006年1月～2009年10月对30例(斜拉桥式组)阴道前壁膨出施行阴道前壁"斜拉桥"式修补术(将阴道前壁两侧膀胱筋膜分别缝于对侧耻骨降支骨膜上),与2002年1月～2006年1月35例(传统术式组)阴道前壁膨出行传统阴道前壁修补术(将膀胱筋膜荷包缝合以使膨出的膀胱回缩)进行比较,比较2组手术时间、术中出血量、手术并发症、术后复发率、术后阴道深度、术后性生活满意情况及保持率。结果 2组手术时间、术中出血量、术后1周内新发尿潴留无统计学差异(P>0.05)。术后12个月阴道深度传统术式组为(5.6±1.1)cm显著短于斜拉桥式组(7.5±0.6)cm(t=-8.440,P=0.000)。传统术式组术后2年复发率20.0%(7/35),显著高于斜拉桥式组0(P=0.010)。术后12个月内性生活保持率传统术式组5.7%(2/35)与斜拉桥式组13.3%(4/30)无统计学差异(χ2=0.395,P=0.530)。结论阴道前壁"斜拉桥"式修补术不用额外材料而将脱垂的组织交叉固定在坚韧有力的骨膜上,借鉴了斜拉桥的构造原理,既加固盆底又经济,且骨膜标志易辨识,手术简单易操作,增加了安全性,临床效果优于传统修复术。

Objective To compare the clinical efficacy of anterior vaginal wall repair of cable-stayed bridge type and traditional anterior vaginal wall repair in the treatment of anterior vaginal wall prolapse. Methods From January 2006 to October 2009, we performed anterior vaginal wall repair of cable-stayed bridge type on 30 patients with anterior vaginal wall prolapse （ cable- stayed bridge group： the bladder fasciae on the both sides of the anterior vaginal wall were sewn to the periosteum of the descending branches of the contralateral pubic bones, respectively）. Another 35 patients with anterior vaginal wall prolapse, who underwent traditional anterior vaginal wall repair （ i. e. , a purse-string suture of the bladder fasciae was made to make bulging bladder retract ） from January 2002 to January 2006 in our hospital was set as a control （ traditional surgery group）. The operation time, blood loss, surgical complications, rate of recurrence, postoperative vaginal depth, and postoperative sex satisfaction and maintenance were compared between the two groups. Results No significant difference existed in the operation time, intraoperative blood loss, incidence of urinary retention within one week after the surgery between the two groups （ all P 〉 0.05 ） , and the maintenance rate of sex activity in 12 months [ 5.7% （2/35） vs. 13.3% （4/30）, X2 = 0. 395, P = 0. 530 ]. The traditional surgery group showed significantly shorter vagina in 12 months after the surgery and higher rate of recurrence in two years than the cable-stayed bridge group[ （5.6 ±1.1） cm, vs. （7.5 ± 0.6） cm,t= -8.440, P=O. O00; 20.0% （7/35） vs. O, P=O. OIO, respectively]. Conclusion Borrowing the principle of cable-stayed bridge, without using any extra materials, we can fix the prolapsed tissues onto the strong periosteum, so that to strengthen the pelvic floor in an economic, simple, and safe method with better clinical outcomes than traditional anterior vaginal wall repair.