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目的探讨腹腔镜下阴道旁修补术治疗育龄期妇女阴道前壁膨出的有效性和安全性。方法 2012年1月-2013年5月行腹腔镜下阴道旁修补术治疗育龄期妇女阴道前壁膨出21例(Ⅲ度5例,Ⅱ度15例,Ⅰ度1例),腹腔镜下暴露耻骨和双侧Cooper韧带及盆侧壁盆筋膜腱弓,阴道穹隆角缝合于同侧坐骨棘,将阴道侧壁缝合于同侧白线。伴子宫脱垂者行腹腔镜下子宫骶骨固定术,伴张力性尿失禁者术中行膀胱颈Cooper韧带悬吊术(Burch)手术,伴阴道后壁脱垂者术中行阴道后壁修补术。术后患者无任何自觉症状定义为主观治愈;盆腔器官脱垂定量系统分期0度定义为客观治愈。结果同时行子宫骶骨固定术5例,行Burch手术3例,阴道后壁修补6例。手术时间110~225 min,平均155 min;术中出血量30~100 m L,平均60 m L;术中均无并发症发生;21例患者手术前后盆腔脏器脱垂评估指示点Aa点分别为(1.0±0.4)cm和(-3.0±0.8)cm,Ba点分别为(1.5±0.4)cm和(-3.0±0.5)cm,手术前后Aa、Ba点值比较,差异具有统计学意义(P<0.01);术后住院时间5~10 d,平均7 d;住院费用为7 000~11 000元,平均8 500元;1例术后2 d拔出尿管后出现尿道梗阻、排便困难,留置尿管7 d好转;21例术后随访10~18个月,平均15个月,19例主观治愈,20例客观治愈。结论腹腔镜下阴道旁修补术治疗育龄期妇女阴道旁缺陷所致的阴道前壁膨出手术创伤小、恢复快,是一种安全有效的治疗方法。
Objective To investigate the effectiveness and safety of laparoscopic vaginal repair in the treatment of women with childbearing age. Methods From January 2012 to May 2013, 21 cases of vaginal anterior pituitary prostheses were treated by laparoscopic vaginoplasty (5 cases of Ⅲ degree, 15 cases of Ⅱ degree, 1 case of Ⅰ degree), laparoscopic exposure Pubis and bilateral Cooper ligament and pelvic side of the pelvis tendon arch bow, vaginal dome stitch suture ipsilateral sciatic spine, the vaginal wall sutured in the ipsilateral white line. Laparoscopic uterine sacral fixation with laparoscopic uterosacral fixation and tension catheter incontinence underwent bladder neck cooper ligament suspension (Burch) surgery with vaginal posterior wall prolapse underwent vaginal posterior wall repair. Postoperative patients without any symptoms defined as subjective cure; pelvic organ prolapse quantitative system staging 0 degrees defined as objective cure. Results 5 cases of uterine sacral fixation at the same time, 3 cases underwent Burch operation, 6 cases of vaginal wall repair. The operative time was 110-225 min with an average of 155 min. The intraoperative blood loss was 30-100 m L, with an average of 60 m L. No complications were found during operation. A point of pelvic organ prolapse assessment was found in 21 patients before and after operation (1.0 ± 0.4) cm and (-3.0 ± 0.8) cm respectively, and the Ba points were (1.5 ± 0.4) cm and (-3.0 ± 0.5) cm respectively. The values of Aa and Ba before and after operation were significantly different P <0.01). The postoperative hospital stay was 5 to 10 days with an average of 7 days. The hospitalization cost was 7,000 to 11,000 yuan, with an average of 8,500 yuan. One case had urethral obstruction , Indwelling catheter 7d improved; 21 cases were followed up for 10 to 18 months, an average of 15 months, 19 cases of subjective cure, 20 cases of objective cure. Conclusions Laparoscopic vaginal repair is a safe and effective method to treat vaginal anterior bulging due to vaginal defects in childbearing women.