阴道旁修补联合骶棘韧带固定术治疗阴道前壁脱垂疗效观察

Efficacy of vaginal paravaginal repair combined with sacrospinous ligament fixation in the treatment of anterior vaginal wall prolapse

目的:探讨经阴道阴道旁修补(VPVR)联合骶棘韧带固定术(SSLF)在阴道前壁脱垂治疗中的疗效及安全性。方法:回顾性分析柳铁中心医院2008年1月至2012年12月57例经盆腔器官脱垂定量分期法进行分期(POP-Q),确定为子宫及阴道前壁脱垂患者的临床资料,按手术方式的不同分为对照组和观察组。对照组32例行传统经阴道子宫切除术(TVH)及阴道前壁修补术,观察组25例在阴式子宫切除(TVH)基础上行阴道旁修补术(VPVR)及骶棘韧带固定术(SSLF)组合术式。术后定期随访,对手术临床效果及并发症情况进行评估。结果:两组手术时间及术中出血量比较对照组优于观察组(P<0.05);术后随防1年,观察组的临床治愈率明显高于对照组(P<0.05);术后不适感发生率观察组明显低于于对照组(P<0.05);两组均未发生膀胱、尿道损伤及其他部位损伤。结论:阴道旁修补联合骶棘韧带固定术修复阴道顶端及中段旁缺陷,较好恢复原有解剖状态,在治疗阴道前壁脱垂中疗效满意。

Objectives： To investigate the efficacy and safety of vaginal paravaginal repair（ VPVR） combined with sacrospinous ligament fixation（ SSLF） operation in the treatment of anterior vaginal wall prolapse.Methods： A retrospective analysis was done on the clinical data of 57 patients with uterus and anterior vaginal wall prolapse evaluated by pelvic organ prolapse quantification（ POP- Q） from Jan. 2008 to Dec. 2012 in Liuzhou Municipal Liutie Central Hospital. The patients were divided into the observation group and control group according to surgery methods. 32 cases in the control group were treated by traditional transvaginal hysterectomy（ TVH） and anterior vaginal wall repair,and 25 cases in the observation group accepted TVH plus VPVR with combined operation of SSLF. The clinical effect and complications were evaluated by regular post- operative follow- up. Results： Compared with the observation group,the conditions of operation time and bleeding volume in control group were better（ P〈0. 05）; After one- year post- operative follow- up,the clinical cure rate in the observation group was significantly higher than that in control group（ P〈0. 05）,and the incidence of postoperative discomfort was significantly lower than that in control group（ P〈0. 05）; No bladder,urethra and other site injuries occurred in both groups.Conclusions： The combined operation model of VPVR and SSLF restore the original anatomic state,and possess a satisfactory efficacy in the treatment of anterior vaginal wall prolapse.