改良阴道桥式缝合术的应用

目的:探讨改良阴道桥式缝合术治疗阴道前壁脱垂合并压力性尿失禁的临床疗效.方法:回顾性分析我院2011年1月至2012年8月行改良阴道桥式缝合术治疗阴道前壁脱垂合并压力性尿失禁21例患者的临床资料.结果:单纯行改良阴道桥式缝合术平均手术出血量为38.57±6.23 ml,平均手术时间为38.48±3.52分钟.未发生膀胱损伤、阴道壁坏死及膀胱尿道阴道瘘、尿潴留等手术并发症.术后3月复查阴道壁愈合良好,所有患者随访1年无阴道前壁脱垂复发.尿失禁治愈18例,改善3例.结论:改良阴道桥式缝合术治疗阴道前壁脱垂合并压力性尿失禁具有手术效果好、创伤小、术式安全有效,无排异反应等优点.     

经阴道阴道旁修补术治疗阴道前壁膨出23例

目的:探讨经阴道阴道旁修补(VPVR)手术治疗阴道前壁膨出的临床疗效。方法:选自我院23例有临床症状的阴道前壁膨出患者行VPVR手术。术后3、6、9、12个月定期随访。结果:23例VPVR手术均获得成功,单计VPVR手术的平均时间为45分钟,平均术中出血量为110ml。术后平均随访7月(1~14月),仅有1例复发。主观治愈率100%,客观治愈率为95.7%。结论:采用经阴道阴道旁修补术是治疗阴道前壁膨出的一种安全有效的方法。     

阴道前壁桥式缝合术修补阴道前壁脱垂的临床观察

目的讨论应用阴道前壁桥式缝合术修补阴道前壁脱垂的疗效与意义。方法选取阴道前壁脱垂患者44例,将其随机分为A、B组。分别行常规阴道前壁修补术(A组)及阴道前壁桥式缝合术(B组)。比较手术执行情况及术后恢复情况等指标。结果行阴道前壁桥式缝合术组患者手术执行情况及术后恢复情况均显著优于常规前壁修复组,差异有统计学意义(P0.05)。结论应用阴道前壁桥式缝合术手术时间短,创伤小且术后复发率低。可显著加快创口恢复速度并提高疗效。     

阴道前壁黏膜瓣悬吊治疗前盆腔器官脱垂52例疗效分析

目的 探讨阴道前壁黏膜瓣悬吊术治疗前盆腔器官脱垂的效果。 方法 回顾性分析郑州大学第二附属医院2005年1月至2010年1月间接受阴道前壁黏膜瓣悬吊术的52例前盆腔器官脱垂患者的临床资料。52例患者同时联合子宫切除术、附件切除术、阴道后壁修补术、骶棘韧带悬吊术、会阴陈旧性裂伤修补术和尿道中段悬吊术6种手术。 结果 52例行阴道前壁黏膜瓣悬吊术均获得成功。阴道前壁黏膜瓣悬吊平均手术时间为(43.5±5.2)min;平均出血量为(50.7±2.5)ml;无血肿发生,无尿道、膀胱及直肠损伤。术后有4例出现尿潴留,给予对症处理后,排尿功能恢复正常。52例术后随访12~60个月,平均随访28.2个月,患者无任何自觉症状,主观治愈率为100%,术后12~24个月复发5例( POP-Q分度法为Ⅰ度),客观治愈率为90.4%。 结论 阴道前壁黏膜瓣悬吊术配合其他缺陷修补的组合术式具有治愈率高,复发率低,无排斥反应,价格低廉,安全易行,近期疗效良好等特点。     

腹腔镜下子宫腹壁悬吊联合阴道前壁修补治疗子宫脱垂84例病例分析

目的:分析腹腔镜下子宫腹壁悬吊联合阴道前壁修补术治疗子宫脱垂的有效性及安全性。方法:选择2014年1月至2018年12月因Ⅲ~Ⅳ度子宫脱垂且合并阴道前壁膨出于溧阳市人民医院就诊的患者共84例,采用腹腔镜下简易子宫腹壁悬吊+阴道前壁修补进行治疗,伴有阴道后壁膨出的患者术中同时行阴道后壁桥式修补。术后随访12~72月(平均36.8月),记录患者术中情况、手术并发症及手术前后盆腔器官脱垂定量分度(POP-Q)及盆底功能影响问卷简表(PFIQ-7)评分。结果:腹腔镜下子宫腹壁悬吊+阴道前壁修补术的手术时间为(47.75±6.73)min,术中出血量(49.41±14.44)ml,无术中脏器损伤。术后1年随访客观治愈率97.6%(82/84),手术并发症发生率7.14%(6/84)。术后1年POP-Q评分中Aa、Ba、C、Ap、Bp各点的值均较术前有明显改善。患者术前PFIQ-7评分(116.29±17.97)分,术后6月评分(25.31±10.15)分,术后1年评分(26.32±7.85)分,差异有统计学意义(P<0.01)。结论:腹腔镜下简易子宫腹壁悬吊联合阴道前壁修补术治疗子宫脱垂操作简单,容易掌握,近期有效率高。     

经阴道前壁路径骶棘韧带悬吊术治疗盆腔器官脱垂的短期疗效分析

目的:观察经阴道前壁路径骶棘韧带悬吊术治疗盆腔器官脱垂(POP)的短期疗效及安全性。方法:回顾性分析2014年2月至2015年8月在皖南医学院附属弋矶山医院行经阴道前壁路径骶棘韧带悬吊术的51例POP患者的临床资料。观察手术时间、手术出血量、住院时间、尿管留置时间,并发症情况,治愈率,生命质量改善情况。结果:患者的平均手术时间为(75.20±24.31)min,平均术中出血量(87.65±74.72)ml,平均术后住院天数(4.31±0.75)天,平均留置尿管时间(3.50±1.30)天。完整随访51例,随访率为100.00%,3例术后复发,治愈率为94.12%。术前与术后POP-Q的Aa、Ba、Ap、Bp、C比较、盆底功能障碍问卷(PFDI-20)评分比较,差异均有统计学意义(P0.05)。术后1月与术后6月阴道前壁Aa、Ba、C点比较,差异无统计学意义(P0.05)。结论:经阴道前壁路径骶棘韧带悬吊术是一种安全、有效的术式,在治疗合并前盆腔缺陷的POP疾病中较传统方式具有优势。     

阴式全子宫切除联合阴道桥式缝合修补术在治疗盆腔器官脱垂中的临床应用

目的探讨阴式全子宫切除联合改良阴道桥式缝合修补术在盆腔器官脱垂中的临床应用价值。方法将北京市通州区妇幼保健院3年来经阴式全子宫切除联合改良阴道桥式缝合修补术治疗的116例子宫脱垂伴阴道前后壁膨出的患者作为研究对象,对手术经过及疗效进行回顾性分析。结果116例患者手术时间平均（60．25±35．65）min;出血量平均（170．34±20．20）ml。术中无副损伤。术后排气时间平均（24．12±4．15）h,残余尿量为0～75ml,平均（SO．00±5．67）ml。术后无感染、出血及心脑血管意外等并发症发生。随访6～36个月,治愈率98．28％。结论阴式全子宫切除联合改良阴道桥式缝合修补术具微创、手术彻底、恢复快的特点,自体阴道壁组织作为生物补片加固盆底、经济实惠、疗效确切,值得临床推广应用。     

改良阴道旁修补术22例临床疗效观察

盆腔脏器脱垂特别是阴道前壁膨出,是影响中老年妇女身体健康和生活质量的常见疾病,临床治疗以手术最为有效,常用阴道前壁修补术。但临床工作发现传统术式治疗效果欠佳,术后复发率较高[1]。我院自2004年用阴道旁修补术并加以改进,采用自体阴道前壁粘膜加强尿道和膀胱支托,临床效     

改良的阴道前壁膨出修补术60例临床效果观察

目的:探讨改良的阴道前壁膨出修补术的可行性和临床价值。方法:对60例阴道前壁膨出、阴道前后壁膨出或合并子宫脱垂患者进行改良的阴道前壁修补术,术后定期随访,对术后复发情况进行客观(临床检查)及主观(患者自觉症状或感觉)评价。结果:60例手术均获成功,术后随访6～18个月,仅有1例于术后12个月临床检查时发生轻度阴道前壁膨出,但患者主观上无自觉症状,无需再次手术。结论:改良的阴道前壁膨出修补术术后临床效果满意,复发率低。     

新式阴道前壁补片修补术在女性压力性尿失禁中治疗效果评估

目的:探讨新式阴道前壁补片修补术术式的创新性及优、缺点,以及其对女性压力性尿失禁(SUI)的近期手术疗效。方法:对2009年1月至2012年2月我院收治的106例女性SUI患者行新式阴道前壁补片修补术。采用主观评价尿失禁问卷简表(ICIQ-SF)、客观评价尿垫试验等方法评价该术式的近期手术疗效。与经典文献Burch手术及TVT等术后1年治愈率比较,探讨此手术的创新性及优、缺点。观察患者的围手术期及术后并发症情况。结果:新式阴道前壁补片修补术术后1年,患者的治愈率为90.57%,ICIQ-SF评分明显降低(P0.001)。与Burch手术、TVT等术后1年的治愈率比较,无显著差异(P0.05)。患者围手术期的尿路感染、排尿不尽等并发症的发生率为9.43%,尚未发现严重术后并发症。结论:本新式阴道前壁补片修补术符合手术目的预期,具有微创化、经济、近期治愈率高和术后并发症率低等优势,但中远期治疗效果需继续随访。     

阴道后壁脱垂患者阴道后壁组织生物力学特征初步研究

目的探讨阴道后壁脱垂患者阴道后壁组织的生物力学特征。方法采用力学研究的方法，对13例绝经后阴道后壁脱垂患者的阴道后壁组织分别进行拉伸强度、应力-应变、应力松弛以及蠕变的力学性能测试。结果按照POP-Q分期，阴道后壁脱垂Ⅱ期患者阴道后壁组织应力-应变关系优于阴道后壁脱垂Ⅲ期患者，但无显著性差异（P〉0．05），阴道后壁脱垂Ⅱ期应力松弛及蠕变性能明显优于Ⅲ期，有显著性差异（P〈0．01）；阴道后壁组织力学性能与患者的BMI无相关性（P〉0．05）；50～59岁、60～69岁和70～79岁年龄组的阴道后壁组织力学性能比较差异均无显著性（P〉0．05）。结论阴道后壁脱垂患者阴道后壁组织的生物力学性能与其脱垂程度有相关性。     

Vaginal paravaginal repair with an AlloDerm graft

OBJECTIVE: This study was undertaken to describe outcomes of a technique of vaginal paravaginal repair that used AlloDerm graft (LifeCell, Branchburg, NJ) in women with recurrent stage II or with primary or recurrent stage III/IV anterior vaginal wall prolapse. STUDY DESIGN: This was an observational study. Thirty-three women underwent a vaginal paravaginal repair using AlloDerm graft. Anterior vaginal wall prolapse was staged using the pelvic organ prolapse quantification system preoperatively and every 6 months after surgery. Recurrence of prolapse, changes in functional status (urinary symptoms, prolapse symptoms, and sexual activity), and complications were recorded. Objective failure was defined as recurrent anterior vaginal wall prolapse, stage II or greater, and subjective failure as symptomatic recurrent anterior vaginal wall prolapse. Life-table analysis evaluated objective and subjective failure. Risk factors for recurrent anterior vaginal wall prolapse were evaluated. RESULTS: The mean age was 65.2 years and 93% of the women were white. Preoperatively, 6 women had recurrent stage II, 24 women had stage III, and 3 women had stage IV anterior vaginal wall prolapse. The median length of follow-up was 18 months. Postoperatively, 12 women had asymptomatic stage II anterior vaginal wall prolapse (not beyond the hymen) develop, and 1 woman had symptomatic stage II prolapse develop. Thus, there were 13 (41%) objective failures and 1 (3%) subjective failure. Life-table analysis demonstrated the cumulative probability of an objective failure was 0.24 at 1 year and 0.50 at 2, 3, and 4 years. The cumulative probability of a subjective failure was 0.00 at 1 and 2 years and 0.11 at 3 and 4 years. No risk factors for objective failure were identified. Voiding complaints resolved in 11 of 14 (79%) women (P=.004), incontinence symptoms resolved in 17 of 19 (89%) women (P<.001), and urgency symptoms resolved in 20 of 23 (87%) women (P<.001) (all two-tailed Fisher exact test). Twenty-one women (64%) were sexually active, and none complained of postoperative dyspareunia. Complications included 1 case of febrile morbidity, 1 cystotomy, and 1 anterior wall breakdown secondary to hematoma formation caused by heparin therapy. No other erosions or rejections were seen. CONCLUSION: Vaginal paravaginal repair with AlloDerm graft in women with recurrent stage II or stage III/IV anterior vaginal wall prolapse is safe and has good subjective but only fair objective success within the first 2 years.     

Urethral Diverticulum Mimicking Anterior Vaginal Wall Prolapse: Case Report

Unfamiliar cystic formations may develop in the anterior vaginal wall. In view of the close proximity of the anterior vagina to the urethra and bladder, it is important that management of such masses is carefully planned after detailed examination and investigation. Herein, we present the case of an unusual painful swelling in the anterior vaginal wall that was first diagnosed as vaginal wall prolapse. Despite thorough preoperative investigations, the origin of the mass as a urethral diverticulum was confirmed only at pathologic analysis.     

Wide genital hiatus is a risk factor for recurrence following anterior vaginal repair

Objective

To determine if a wide genital hiatus is a risk factor for recurrence of anterior vaginal wall prolapse following anterior vaginal repair.

Methods

A retrospective cohort study was performed on patients who had undergone an anterior vaginal wall repair. Patients were placed into 1 of 2 groups: wide genital hiatus (≥ 5 cm) or normal genital hiatus (< 5 cm). The wide genital hiatus group (n = 35) was compared with the normal genital hiatus group (n = 30) for surgical failure.

Results

There were no significant differences between the 2 groups in demographic data, additional operative procedures, or apical suspensions. The rate of postoperative anterior vaginal wall prolapse was greater in patients with a wide genital hiatus compared with those with a normal genital hiatus (34.3% vs 10% respectively; odds ratio 4.7 [95% confidence interval, 1.0-24.1]; P = 0.02).

Conclusion

The rate of recurrent anterior vaginal wall prolapse is higher in patients with a wide genital hiatus.     

Vaginal rejuvenation: improving sex by design?

Vaginal rejuvenation includes a range of procedures designed to reduce the internal and external diameters of the vagina, mainly to improve sexual function and/or the appearance of the vagina. Women with symptoms of vaginal laxity because of childbirth or aging, seek these procedures. Conventional treatments include topical oestrogens, Kegel's exercises and corrective surgery to restore the pelvic floor. Newer minimally invasive treatments like carbon dioxide (CO₂) or erbium-doped yttrium aluminium garnet (Er–YAG) laser and radiofrequency ablation of the vagina are becoming widely available and increasingly popular. Although these treatments have limited scientific evidence, they seem to be effective in improving vaginal laxity and providing symptom relief.     

Vaginal sarcoma: the Royal Marsden experience

Six patients with vaginal sarcoma are reported here. This clinicopathologic review confirms the poor prognosis of this disease. However, there were three 5-year survivors, all of whom had early stage disease and low to intermediate grade tumors. Apart from tumor grade, stage was of prognostic importance. Late recurrences at 5 and 21 years were noted in two of the three 5-year survivors. Neither chemotherapy nor radiotherapy were of use in the treatment of late stage or recurrent disease.     

采用聚丙烯网片的阴道前壁修补术治疗阴道前壁脱垂临床效果的荟萃分析

目的:比较聚丙烯网片和传统的前壁修补术对阴道前壁脱垂患者的临床效果及并发症。方法:通过Pubmed数据库、Cochrane图书馆数据库、荷兰医学文摘(EMBASE)、OVID数据库,收集国外已发表的1990年至2013年符合要求的英文随机对照实验,按纳入和排除标准进行筛选和质量评估,采用RevMan 5.2对手术失败率、术后新增压力性尿失禁、新增的性交困难、术后尿储留进行meta分析。结果:经筛选,共纳入10篇符合要求的随机对照文献,共1288例受试者。与传统的前壁修补术比较,使用聚丙烯网片能明显降低手术的失败率(P0.01,RR=0.37,95%CI为0.31~0.45),术后新增的压力性尿失禁和性交困难则无显著差异(P=0.10,RR=1.52,95%CI为0.93~2.48;P=0.16,RR=1.99,95%CI为0.97~4.08),术后尿储留网片发生率较高(P0.05,RR=2.31,95%CI为1.10~4.83)。结论:使用聚丙烯网片能显著降低手术的失败率和术后复发率,但在术后并发症上无特殊优势,并且术后尿储留的发生率略高。     

Assessment of Collagen-Coated Anterior Mesh Through Morphology and Clinical Outcomes in Pelvic Reconstructive Surgery for Pelvic Organ Prolapse

Study ObjectiveTo assess the morphologic features of anterior armed transobturator collagen-coated polypropylene mesh and its clinical outcomes in pelvic reconstructive surgery to treat pelvic organ prolapse.DesignEvidence obtained from several timed series with intervention (Canadian Task Force classification II-3).SettingChang Gung Memorial Hospital, Taoyuan, Taiwan, China.PatientsBetween April 2010 and October 2012, 70 patients underwent surgery to treat symptomatic pelvic organ prolapse, stage III/IV according to the POP-Q (Pelvic Organ Quantification System).InterventionAnterior armed transobturator collagen-coated mesh.Measurement and Main Results: Morphologic findings and clinical outcome were measured. Morphologic features were assessed via 2-dimensional introital ultrasonography and Doppler studies. Clinical outcome was measured via subjective and objective outcome. Objective outcome was assessed via the 9-point site-specific staging method of the International Continence Society Pelvic Organ Prolapse Quantification before the operation and at 1-year postoperative follow-up. Subjective outcome was based on 4 validated questionnaires: the 6-item UDI-6 (Urogenital Distress Inventory), the 7-item IIQ-7 (Incontinence Impact Questionnaire), the 6-item POPDI-6 (Pelvic Organ Prolapse Distress Inventory 6), and the 12-item PISQ-12 (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire), at baseline and at 12 months after the operation. Data were obtained for 65 patients who underwent the combined surgery and were able to comply with follow-up for >1 year. Ultrasound studies reveal that mesh length tends to shorten and decrease in thickness over the 1-year follow-up. Vagina thickness also was reduced. Neovascularization through the mesh was observed in <8.5% of patients in the first month and at 1 year, and was evident in approximately 83%. The mesh exposure rate was 6.4%. The recorded objective cure was 90.8% (59 of 65 patients), and subjective cure was 89.2% (58 of 65 patients) at mean (SD) follow-up of 19.40 (10.98) months. At 2 years, UDI-6, IIQ-7, and POPDI-6 scores were all significantly decreased (p < .001), whereas the PISQ-12 score was significantly increased (p = .01).ConclusionsUltrasound features suggest that the degeneration of collagen barrier may be longer than expected and that integration of collagen-coated mesh could occur up to 1 year. A substantially good clinical outcome was noted.     

Anterior abdominal wall cervicopexy for treatment of stage III and stage IV uterine prolapse

Objective

To study the operative and postoperative outcomes of anterior abdominal wall cervicopexy (AWC) for treatment of stage III and stage IV uterine prolapse.

Methods

AWC was performed by anchoring the supravaginal cervix to the anterior abdominal wall. This was done following obliteration of the pouch of Douglas via laparotomy.

Results

Among 37 patients, AWC was performed in 21 women with stage III and 16 women with stage IV uterine prolapse. Overcorrection was observed in 3 women. Postoperatively, 2 women experienced febrile morbidity and 5 had urinary retention. Thirteen women complained of urinary frequency, but all reported improvement at 3-month follow up. Among 24 women who became pregnant, 14 delivered vaginally, 5 delivered by cesarean, and 5 had an ongoing pregnancy. Four recurrences occurred: 2 stage II and 2 stage III prolapses. Three of these women had delivered by cesarean, while the fourth recurrence occurred after the patient's third vaginal birth.

Conclusions

AWC is a simple and effective procedure to treat stage III and stage IV uterine prolapse. However, some surgical modifications and more studies are required to ascertain its validity.