腹腔镜下燕尾服式骶骨固定术4例报道

Laparoscopic sacrum fixation with swallow-tailed mesh:a report of 4 cases

目的:探讨燕尾服式骶骨固定术式治疗中盆腔和(或)合并后盆腔缺陷的可行性及临床疗效。方法:回顾性分析2019年重庆市妇幼保健院采用燕尾服式骶骨固定术治疗中盆腔和(或)合并后盆腔缺陷的4例患者临床资料,本研究使用自裁的网片和自行设计的穿刺锥完成手术。结果:4例患者均诊断为中盆腔合并后盆腔缺陷,其中3例为子宫脱垂伴阴道后壁膨出,1例为穹窿脱垂伴肠疝患者;4例患者均接受燕尾服式骶骨固定术并成功完成手术,无辅助阴式修补和中转开腹病例,术中无肠管等器官损伤的并发症发生。手术平均时间166 min,术中平均出血量为68 mL。所有患者在术后5~6 d均顺利出院,随访中超声提示盆腔脏器位置正常,网片覆盖平整,直肠阴道检查网片平铺无张力,且阴道后壁柔软无膨出。结论:燕尾服式骶骨固定术可以在修复和加强Ⅰ水平缺陷的同时修复加强Ⅱ、Ⅲ水平缺陷,是治疗中盆腔缺陷、中盆腔合并后盆腔的有效方法,也适用于后盆腔缺陷疾病的诊治。

Objective:To explore the feasibility and clinical effect of laparoscopic sacrum fixation with swallow-tailed mesh in the treatment of middle and/or combined posterior pelvic cavity defects.Methods:The clinical data of 4 patients with middle and/or combined posterior pelvic cavity defects treated by laparoscopic sacrum fixation with swallow-tailed mesh in Chongqing Health Center for Women and Children in 2019 were analyzed retrospectively.In this study,self-made mesh and self-designed puncture cone were used to complete the operation.Results:Four patients were diagnosed as middle pelvic cavity combined with posterior pelvic defects,including 3 cases of uterine prolapse with vaginal posterior wall expansion,and 1 case of vaginal vault prolapse with enterocele.All patients received swallow-tailed sacrum fixation and successfully suffered from the operation,without auxiliary vaginal repairment and conversion to open abdomen,and no complications of intestinal tube and other organ damage during the operation.The average time of operation was 166 min,and the average amount of bleeding was 68 mL.All the patients were discharged smoothly 5-6 days after operation.According to the follow-up,ultrasound showed that the pelvic organs were in normal position,the mesh coverage was flat,the rectal and vaginal examination mesh was flat without tension,and the posterior wall of the vagina was soft without swelling.Conclusion:The swallow-tailed sacrum fixation can repair and strengthen the levelⅠdefects as well as the levelⅡandⅢdefects,which is an effective method for the treatment of the middle pelvic cavity defects and the combination of the middle and the posterior pelvic cavity defects,and is also suitable for the diagnosis and treatment of the posterior pelvic cavity defects.