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目的探讨经阴道子宫骶骨韧带高位悬吊术(HUS)治疗子宫脱垂的解剖生理基础、适应证、手术技巧、输尿管损伤的预防及临床近、中期疗效。方法 2003年6月至2007年9月,采用经阴道 HUS 悬吊阴道穹隆、重建耻骨宫颈筋膜及直肠阴道筋膜,治疗中、重度子宫脱垂50例。患者平均年龄60.1岁,术后平均随访时间24个月(4～51个月)。同时采用盆腔器官脱垂定量分度(POP-Q)法对子宫脱垂程度及手术后结果进行评价,以术后 C 点值≤POP-Q Ⅰ度计算成功率。结果术中50例中、重度子宫脱垂患者的宫骶韧带均可在后腹膜坐骨棘内后侧、经长组织钳钳夹牵拉、清楚触及和辨认,并均成功对阴道穹隆进行了悬吊和筋膜重建。术中应根据对输尿管解剖部位和相邻关系的准确认识、术中触摸、掌握缝合进针深度及方向、膀胱镜检查并确认输尿管开口位置等方法避免输尿管损伤。50例中,无一例输尿管损伤。术后平均随访时间24个月,POP-Q 法 C 点值由术前1.5 cm降为术后的-7.5 cm;主、客观成功率均达100%。结论经阴道 HUS 悬吊并重建阴道穹隆、耻骨宫颈筋膜、直肠阴道筋膜是利用自身组织作为悬吊点治疗子宫脱垂,符合恢复解剖生理、保留功能及微创原则,主、客观成功率高。
Objective To investigate the anatomic and physiological basis, indications, surgical techniques, prevention of ureteral injury and clinical short-term and long-term clinical effects of transvaginal uterosacral ligament suspension (HUS) for uterine prolapse. Methods From June 2003 to September 2007, 50 cases of medium and severe uterine prolapse were treated with transvaginal HUS suspension of vaginal dome and reconstruction of pubic cervical fascia and rectovaginal fascia. The mean age of patients was 60.1 years and the average follow-up time was 24 months (range 4-51 months). The pelvic organ prolapse quantitative index (POP-Q) method was used to evaluate the degree of uterine prolapse and the postoperative results, and the success rate was calculated by the postoperative C value ≤POP-Q Ⅰ. Results 50 cases of intraoperative and severe uterine prolapse in patients with uterosacral ligaments in the posterior peritoneal ischial spine medial posterior, long tissue forceps clamp pull, clearly touched and identified, and were successful in the vaginal fornix hanging Hanging and fascia reconstruction. Surgery should be based on accurate understanding of the ureteral anatomy and adjacent relations, intraoperative touch, to grasp the depth and direction of suture needle, cystoscopy and confirm the location of ureteral openings and other methods to avoid ureteral injury. None of the 50 patients had ureteral injury. The average follow-up time was 24 months. The POP-Q value decreased from 1.5 cm before surgery to -7.5 cm postoperatively. Both the objective and objective rates of success reached 100%. Conclusions Transvaginal HUS suspension and reconstruction of the vaginal vault, pubic cervical fascia, rectovaginal fascia is the use of its own tissue as a hanging point treatment of uterine prolapse, in line with the restoration of anatomical and physiological, retention and minimally invasive principle, the main objective success rate high.