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目的 探讨经阴道途径行阴道旁修补 (VPVR)手术治疗中、重度阴道前壁及膀胱膨出的有效性和安全性。方法 采用VPVR手术,治疗 25例有临床症状、经盆腔器官脱垂定量 (POP-Q)分度法和Baden-Walker盆腔器官脱垂的阴道半程系统分度法,确定为阴道前壁及膀胱膨出的患者,其中,POP-Q分度法为Ⅲ~Ⅳ度者占 92%。VPVR手术主要包括经阴道于耻骨降支下进入耻骨后间隙,暴露盆腔筋膜腱弓(ATFP),用不可吸收线将盆腔内筋膜、盆腔筋膜腱弓及膀胱筋膜逐一缝合,关闭阴道旁缺陷等步骤。同时进行其他盆底修复手术共 11种。术后定期随访,对手术效果进行主观(患者自觉症状或感觉)及客观(临床检查)评价。结果 25例行VPVR手术均获得成功。手术时间平均为 40min,出血量平均为 70ml;有 2例术中耻骨后静脉丛出血,分别为 100ml及 200ml。无其他手术并发症,无术后病率。有 2例术后发生排尿困难及尿潴留, 1例于短期内痊愈,另 1例为术后 2个月现仍在治疗中。25例术后随访 2 ~14个月,平均 6个月,患者无任何自觉症状,主观治愈率为100%。2、6个月随访时,各有 1例临床检查发现为复发(POP-Q分度法为Ⅰ度),客观治愈率为 92%。结论 VPVR手术可以恢复耻骨宫颈筋膜附着在盆腔侧壁的解剖位置,对纠正中、重度阴道前壁及膀胱膨出,是安全、有效的。
Objective To investigate the efficacy and safety of transvaginal approach (VPVR) in the treatment of moderate and severe vaginal anterior wall and cystocele. Methods VPVR was used to treat 25 cases of patients with clinical symptoms. The pelvic organ prolapse quantitative (POP-Q) index and pelvic organ prolapse of Baden-Walker vaginal half-system indexing were determined as the anterior vaginal wall and the bladder Patients with bulging, of which, POP-Q indexing method for the Ⅲ ~ Ⅳ who accounted for 92%. VPVR surgery mainly involves the transvaginal subcutaneous into the retropubic space under the pubic symphysis to expose the pelvic fascia tendon arch (ATFP), non-absorbable line will pelvic fascia, pelvic fascia tendon arch and bladder fascia one by one suture, close the vagina Side defects and other steps. At the same time, other pelvic floor repair surgery a total of 11 species. Regular follow-up after surgery, the subjective efficacy of the subjective (patients with symptoms or feeling) and objective (clinical examination) evaluation. Results 25 cases of VPVR surgery were successful. The average operation time was 40min, the average amount of bleeding was 70ml; there were 2 cases of bleeding after the pubic symphysis, respectively 100ml and 200ml. No other surgical complications, no postoperative morbidity. There were 2 cases of dysuria and urinary retention after surgery, 1 case recovered in the short term, the other 1 case is still under treatment after 2 months. 25 cases were followed up for 2 to 14 months, an average of 6 months, patients without any symptoms, the subjective cure rate was 100%. At 1, 2 months of follow-up, 1 patient had a recurrence (1 degree for POP-Q) and an objective cure rate of 92%. Conclusions VPVR can restore the attachment of pubic cervical fascia to the anatomical site of the pelvic wall. It is safe and effective to correct the anterior and posterior wall of the vagina and cystocele.