改良阴道前壁修补术在老年女性阴道前壁及膀胱膨出治疗中的应用

The efficacy and safety of modified anterior vaginal wall repair for anterior vaginal prolapse and cystocele in elderly women

目的探讨改良阴道前壁修补术治疗老年女性阴道前壁及膀胱膨岀的有效和安全性。方法回顾性分析采用改良阴道前壁修补术治疗58例有临床症状，经盆腔脏器脱垂定量（POP-Q）分度法确定为阴道前壁及膀胱膨岀的老年女性患者。改良阴道前壁修补术，以阴道旁修补术为基础，一方面结合前壁反桥式修补术；另一方面，从阴道修补的＂织补法＂受到启发，增加双侧缝线互相交叉打结。并根据患者情况，同时行其他盆底修复和陈旧会阴裂伤修补术、尿道旁筋膜加固等。术后定期随访，对疗效进行主观和客观评价。结果58例手术均获成功，随访时间为6～24个月，平均（14±8）个月，术后3个月随诊（58例），患者主观治愈率100%，阴道顶端位于坐骨棘水平或以上，客观治愈率100%。术后6个月随诊（58例），患者主观治愈率100%，客观治愈率96.6%（56例）。术后12个月随诊（34例），患者主观治愈率100%，客观治愈率94.1%（32例）。术后24个月随诊（12例），患者主观治愈率91.7%（11例），客观治愈率91.7%（11例）。结论改良阴道前壁修补术，治疗老年女性阴道前壁及膀胱膨岀安全、有效，根据患者情况，与其他盆底修复手术组合，是治疗盆腔脏器脱垂的一种好方法。

ObjectiveTo investigate the efficacy and safety of modified anterior vaginal wall repair in the treatment of anterior vaginal prolapse and cystocele in elderly women.MethodsWe retrospectively analyzed the clinical value of modified anterior vaginal wall repair in 58 elderly women with stage Ⅱ-Ⅳ anterior vaginal prolapse and cystocele, which were evaluated by pelvic organ prolapse quantitation （POP-Q） system.The modified anterior vaginal wall repair was based on the paravaginal repair as an add-on to a reverse bridge repair and cross stitching of bilateral sutures stemmed from vaginal repair.According to the condition of each patient, other pelvic floor repair, perineal laceration repair, and paraurethral fascia reinforcement might be performed at the same time.The curative effectiveness was subjectively and objectively evaluated in the postoperative follow-up.ResultsA total of 58 operations were successfully finished.The follow-up time was 6-24 months with an average of （14±8） months.The subjective cure rate was 100% and the rate of objective cure defined as the top of the vagina above the level of ischial spine was 100% at 3-months follow-up （n=58）. The subjective and objective cure rate was 100% and 96.6% （56/58） at 6 months follow-up （n=58）, 100% and 94.1% （32/34） at 12 months follow-up （n=34）, 91.7% （11/12） and 91.7% （11/12） at 24 months follow-up （n=12）, respectively.ConclusionsThe modified anterior vaginal wall repair is safe and effective for anterior vaginal prolapse and cystocele in elderly women.