A transvaginal approach to repair of apical and other associated sites of pelvic organ prolapse with uterosacral ligaments
A transvaginal approach to repair of apical and other associated sites of pelvic organ prolapse with uterosacral ligaments
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DOI：
10.1067/mob.2000.110910
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发表时间：
2000-12-01
影响因子：
9.8
通讯作者：
Kuehl, TJ
中科院分区：
文献类型：
--
作者：
Shull, BL;Bachofen, C;Kuehl, TJ
目的：本研究的目的是(1)描述一组盆腔器官脱垂并伴有根尖支持丧失的女性，(2)描述支持缺陷的手术修复，(3)报告与手术修复相关的发病率，以及(4)评估每个部位修复的持久性。研究设计：从1994年1月1日至1998年12月31日，共有302名患有根尖及相关其他支持缺陷的女性在矫治手术前、中、后进行评估。并在资深作者(鲍勃·L·舒尔)的纠正手术后。所有患者均接受了经阴道天然组织重建术。289名患者(96%)至少有一次术后回访，他们构成了用于随访数据的组。围手术期发病率被认为包括需要输注同种异体血的出血、内脏损伤、神经损伤或死亡。结果：所有患者术前或术中均有1级或更大程度的根尖支持丧失，并至少有一个其他部位的盆腔器官脱垂。289名患者(96%)术后至少复诊一次。251名患者(组1，87%)具有最佳的解剖结果，在任何部位均无持续性或复发性支撑性缺陷。38名患者(组2，13%)在随访期间有一个或多个部位至少失去了1级支持。在这38名患者中，有24名患者有1级缺陷，只有仔细的骨盆检查才能发现。这些患者中有14名(5%)有2级或更大的持续性或复发性支持缺陷。前段(膀胱)是支撑性缺陷持续或复发最多的部位，这意味着它是最不耐久修复的部位。尿路和袖口的修复是最持久的。并发症包括输血率为1%，输尿管损伤或扭曲发生率为1%，术后死亡率为0.3%。结论：术前和术中仔细评估骨盆支持缺陷以及使用天然结缔组织和子宫骶部韧带与良好的解剖结果相关。手术矫正的持久性因修复部位和术后随访时间的不同而不同。
OBJECTIVE: The objectives of this study were (1) to describe a group of women with pelvic organ prolapse associated with apical loss of support through grading with the Baden-Walker halfway system before, during, and after the corrective operation, (2) to describe the operative repair of the support defects, (3) to report the morbidity associated with the operative repair, and (4) to assess the durability of the repair at each site.STUDY DESIGN: Between January 1, 1994, and December 31, 1998, a total of 302 consecutive women with apical and associated other support defects were evaluated before, during, and after the corrective operation by the senior author (Bob L. Shull). All patients underwent transvaginal reconstructive surgery with native tissue. Two hundred eighty-nine patients (96%) returned for at least one postoperative visit, and they constitute the group used for the follow-up data. Perioperative morbidity was considered to include hemorrhage necessitating homologous blood transfusion, visceral injury, neurologic impairment, or death. Durability was assessed by means of life-table analysis for each of 5 sites in the vagina.RESULTS: All patients had preoperative or intraoperative evidence of grade 1 or greater apical loss of support of and at least one other site of pelvic organ prolapse. Two hundred eighty-nine patients (96%) returned for at least one postoperative visit. Two hundred fifty-one patients (group 1, 87%) had optimal anatomic outcomes, with no persistent or recurrent support defects at any site. Thirty-eight patients (group 2, 13%) had one or more sites with at least grade 1 loss of support during the follow-up interval. Twenty-four of these 38 patients had grade 1 defects that were detectable only on careful pelvic examination. Fourteen of these patients (5%) had grade 2 or greater persistent or recurrent support defects. The anterior segment (bladder) was the site with the most persistent or recurrent support defects, which means that it was the site of the least durable repair. The urethra and cuff had the most durable repairs. Morbidity included a 1% transfusion rate, a 1% ureteral injury or ureteral kinking rate, and a 0.3% postoperative death rate.CONCLUSION: Careful preoperative and intraoperative evaluation of pelvic support defects and the use of native connective tissue and uterosacral ligaments are associated with excellent anatomic outcomes. The durability of the surgical correction varies according to the individual site of repair and the duration of postoperative follow-up.