高位宫骶韧带悬吊术治疗中盆腔缺陷的研究进展

doi:10.12280/gjfckx.20200493

摘要/Abstract

摘要：

中盆腔缺陷是盆腔器官脱垂的常见类型,严重影响女性的生活质量。目前临床上治疗中盆腔缺陷的手术方式众多,但缺乏统一的术式选择标准,高位宫骶韧带悬吊术即在坐骨棘水平上1~3 cm缝合骶韧带,悬吊阴道穹隆并重建耻骨宫颈和阴道直肠筋膜,其作为采用自体组织修复中盆腔缺陷的手术,因能较好地恢复顶端支持结构、并发症少、再手术率低、费用低等优点,逐渐广泛应用于临床。就高位宫骶韧带悬吊术不同手术入路的操作步骤、临床效果及围手术期情况等进行综述。

关键词: 骨盆, 内脏下垂, 阴道, 韧带, 解剖学, 局部, 手术后期间

Abstract:

Middle compartment defect seriously affects the quality of life with women, which is a common type of pelvic organ prolapse. At present, clinically surgical approaches for middle compartment defect is numerous, but lack a unified selection standard for surgical methods. High uterosacral ligament suspension is performed by suturing the sacral ligament 1-3 cm above the ischial spine level, suspending the vaginal vault, and reconstructing the pubocervical fascia and the rectovaginal fascia. It has been widely used as a technique that repairs middle compartment defect with autogenic tissues, because it can restore apical support structure better and has less complications, lower reoperation rates and low cost. This article is a review about procedures, therapeutical effect and perioperative situation of different surgical approaches for high uterosacral ligament suspension.

Key words: Pelvis, Visceral prolapse, Vagina, Ligaments, Anatomy, regional, Postoperative period

王倩, 夏志军. 高位宫骶韧带悬吊术治疗中盆腔缺陷的研究进展[J]. 国际妇产科学杂志, 2021, 48(2): 213-218.

WANG Qian, XIA Zhi-jun. Research Progress of High Uterosacral Ligament Suspension in the Treatment of Middle Compartment Defect[J]. Journal of International Obstetrics and Gynecology, 2021, 48(2): 213-218.

参考文献 38

[1]	李志毅, 朱兰, 徐涛, 等. 中国城市地区女性盆腔器官脱垂临床流行病学调查[J]. 中华医学杂志, 2019,99(11):857-861. doi: 10.3760/cma.j.issn.0376-2491.2019.11.012.
[2]	夏志军. 女性泌尿盆底疾病临床诊治[M]. 北京: 人民卫生出版社, 2016: 207-209.
[3]	Shull BL, Bachofen C, Coates KW, et al. A transvaginal approach to repair of apical and other associated sites of pelvic organ prolapse with uterosacral ligaments[J]. Am J Obstet Gynecol, 2000,183(6):1365-1373. doi: 10.1067/mob.2000.110910. doi: 10.1067/mob.2000.110910 pmid: 11120498
[4]	商晓, 朱兰, 郎景和, 等. 宫骶韧带悬吊术的中国女性在体生物力学研究[J]. 中华妇产科杂志, 2018,53(10):700-704. doi: 10.3760/cma.j.issn.0529-567x.2018.10.009.
[5]	DeLancey JO. Anatomy and biomechanics of genital prolapse[J]. Clin Obstet Gynecol, 1993,36(4):897-909. doi: 10.1097/00003081-199312000-00015. doi: 10.1097/00003081-199312000-00015 pmid: 8293591
[6]	鲁永鲜. 女性盆底结构重建术的现状[J]. 实用妇产科杂志, 2005,21(3):135-137. doi: 10.3969/j.issn.1003-6946.2005.03.004.
[7]	Miller NF. A new method of correcting complete invention of the vagina[J]. Surg Gynecol Obstet, 1927,44:550-555.
[8]	Wu MP. Laparoscopic uterine suspension for the treatment of uterovaginal prolapse[J]. Int J Gynaecol Obstet, 1997,59(3):259-260. doi: 10.1016/S0020-7292(97)00204-X. doi: 10.1016/s0020-7292(97)00204-x pmid: 9486519
[9]	Lowenstein L, Fitz A, Kenton K, et al. Transabdominal uterosacral suspension: outcomes and complications[J]. Am J Obstet Gynecol, 2009, 200(6): 656.e1-e5. doi: 10.1016/j.ajog.2009.01.029. doi: 10.1016/j.ajog.2009.01.029
[10]	Milani R, Frigerio M, Cola A, et al. Outcomes of Transvaginal High Uterosacral Ligaments Suspension: Over 500-Patient Single-Center Study[J]. Female Pelvic Med Reconstr Surg, 2018,24(3):203-206. doi: 10.1097/01.spv.0000533751.41539.5b. doi: 10.1097/01.spv.0000533751.41539.5b pmid: 29697546
[11]	鲁永鲜, 沈文洁, 刘昕, 等. 经阴道子宫骶骨韧带高位悬吊术治疗子宫脱垂的临床探讨[J]. 中华妇产科杂志, 2007,42(12):797-801. doi: 10.3760/j.issn:0529-567x.2007.12.003.
[12]	段磊, 鲁永鲜, 沈文洁, 等. 经阴道宫骶韧带高位悬吊术的远期疗效研究[J]. 中华妇产科杂志, 2017,52(6):363-368. doi: 10.3760/cma.j.issn.0529-567x.2017.06.002.
[13]	Milani R, Manodoro S, Cola A, et al. Transvaginal uterosacral ligament hysteropexy versus hysterectomy plus uterosacral ligament suspension: a matched cohort study[J]. Int Urogynecol J, 2020,31(9):1867-1872. doi: 10.1007/s00192-019-04206-2. doi: 10.1007/s00192-019-04206-2 pmid: 31848662
[14]	Jelovsek JE, Barber MD, Brubaker L, et al. Effect of Uterosacral Ligament Suspension vs Sacrospinous Ligament Fixation With or Without Perioperative Behavioral Therapy for Pelvic Organ Vaginal Prolapse on Surgical Outcomes and Prolapse Symptoms at 5 Years in the OPTIMAL Randomized Clinical Trial[J]. JAMA, 2018,319(15):1554-1565. doi: 10.1001/jama.2018.2827. pmid: 29677302
[15]	Pedersen KD, Storkholm MH, Bek KM, et al. Recurrent apical prolapse after high uterosacral ligament suspension-in a heterogenous cohort characterised by a high prevalence of previous pelvic operations[J]. BMC Womens Health, 2019,19(1):96. doi: 10.1186/s12905-019-0800-8. doi: 10.1186/s12905-019-0800-8 pmid: 31299946
[16]	朱兰, 郎景和, 胡惠英, 等. 腹腔镜高位宫骶韧带悬吊术治疗年轻子宫脱垂患者的疗效[J]. 中华妇产科杂志, 2008,43(11):865-866. doi: 10.3321/j.issn:0529-567X.2008.11.017.
[17]	宋秀芝. 腹腔镜下高位骶韧带悬吊术治疗子宫脱垂的效果观察[J]. 中国继续医学教育, 2018,10(30):128-130. doi: 10.3969/j.issn.1674-9308.2018.30.053.
[18]	鲍如如. 腹腔镜下高位骶韧带悬吊术治疗子宫脱垂的效果观察[J]. 保健文汇, 2018(2):44. doi: 10.3969/j.issn.1671-5217.2018.02.044.
[19]	李红. 腹腔镜下子宫骶韧带高位悬吊术治疗子宫脱垂临床效果分析[J]. 中国保健营养, 2018,28(13):231-232. doi: 10.3969/j.issn.1004-7484.2018.13.291.
[20]	刘亚丽. 腹腔镜下子宫骶韧带高位悬吊术治疗64例子宫脱垂患者的临床效果[J]. 首都食品与医药, 2019,26(13):20. doi: 10.3969/j.issn.1005-8257.2019.13.015.
[21]	朱亚丽. 腹腔镜下高位骶韧带悬吊术治疗子宫脱垂的效果分析[J]. 河南医学研究, 2017,26(22):4145-4146. doi: 10.3969/j.issn.1004-437X.2017.22.070.
[22]	张勇. 腔镜下高位骶韧带悬吊术治疗子宫脱垂腹的疗效分析[J]. 中国急救医学, 2017,37(2):121-122. doi: 10.3969/j.issn.1002-1949.2017.z2.099.
[23]	Haj Yahya R, Chill HH, Herzberg S, et al. Anatomical Outcome and Patient Satisfaction After Laparoscopic Uterosacral Ligament Hysteropexy for Anterior and Apical Prolapse[J]. Female Pelvic Med Reconstr Surg, 2018,24(5):352-355. doi: 10.1097/SPV.0000000000000446. doi: 10.1097/SPV.0000000000000446 pmid: 28658003
[24]	Haj-Yahya R, Chill HH, Levin G, et al. Laparoscopic Uterosacral Ligament Hysteropexy vs Total Vaginal Hysterectomy with Uterosacral Ligament Suspension for Anterior and Apical Prolapse: Surgical Outcome and Patient Satisfaction[J]. J Minim Invasive Gynecol, 2020,27(1):88-93. doi: 10.1016/j.jmig.2019.02.012. doi: 10.1016/j.jmig.2019.02.012 pmid: 30802607
[25]	杨纪实, 周留林. 子宫骶骨韧带高位悬吊术治疗子宫脱垂的临床研究[J]. 实用临床医药杂志, 2009,13(17):63-64. doi: 10.3969/j.issn.1008-6633.2009.05.052.
[26]	Lowenstein L, Baekelandt J, Paz Y, et al. Transvaginal Natural Orifice Transluminal Endoscopic Hysterectomy and Apical Suspension of the Vaginal Cuff to the Uterosacral Ligament[J]. J Minim Invasive Gynecol, 2019,26(6):1015. doi: 10.1016/j.jmig.2019.04.007. pmid: 30980991
[27]	Matanes E, Lauterbach R, Mor O, et al. Transvaginal Natural Orifice Transluminal Endoscopic Hysterectomy and Apical Suspension of the Vaginal Cuff to the Utero-Sacral Ligament Learning Curve: Our Experience with the First 30 Cases[J]. J Minim Invas Gyn, 2019,26(7):S28. doi: 10.1016/j.jmig.2019.09.534.
[28]	鲁永鲜. 高位骶韧带悬吊术适应证、手术技巧及手术视频[EB/OL]. [2017-02-17].https://www.docin.com/p-1850695888.html.
[29]	鲁永鲜. HUS手术录像摘要[C]. 厦门:中华医学会第十次全国妇产科学术会议妇科盆底会场, 2012.
[30]	张迎辉, 鲁永鲜, 刘昕, 等. 经阴道宫骶韧带高位悬吊术为主体术式的自体组织修补手术治疗中盆腔缺陷的五年疗效[J]. 中华妇产科杂志, 2019,54(7):445-451. doi: 10.3760/cma.j.issn.0529-567x.2019.07.003.
[31]	张坤, 韩劲松. 腹腔镜下高位骶韧带悬吊术治疗子宫脱垂的疗效探讨[J]. 中国妇产科临床杂志, 2013,14(2):106-109. doi: 10.3969/j.issn.1672-1861.2013.02.004.
[32]	Shatkin-Margolis A, Pauls RN. Sexual function after prolapse repair[J]. Curr Opin Obstet Gynecol, 2017,29(5):343-348. doi: 10.1097/GCO.0000000000000403. doi: 10.1097/GCO.0000000000000403 pmid: 28777192
[33]	Paz-Levy D, Yohay D, Neymeyer J, et al. Native tissue repair for central compartment prolapse: a narrative review[J]. Int Urogynecol J, 2017,28(2):181-189. doi: 10.1007/s00192-016-3032-6. pmid: 27209309
[34]	Krishnan S. Geriatric Pelvic Organ Prolapse Surgery: Going the Extra Mile[J]. J Obstet Gynaecol India, 2017,67(6):428-431. doi: 10.1007/s13224-017-0997-0. doi: 10.1007/s13224-017-0997-0 pmid: 29162957
[35]	Barber MD, Visco AG, Weidner AC, et al. Bilateral uterosacral ligament vaginal vault suspension with site-specific endopelvic fascia defect repair for treatment of pelvic organ prolapse[J]. Am J Obstet Gynecol, 2000,183(6):1402-1410. doi: 10.1067/mob.2000.111298. pmid: 11120503
[36]	鲁永鲜, 王佳, 沈文洁, 等. 经阴道子宫骶骨韧带高位悬吊术治疗重度盆腔器官脱垂的长期疗效[J]. 中华妇产科杂志, 2013,48(8):564-569. doi: 10.3760/cma.j.issn.0529-567x.2013.08.002.
[37]	Houlihan S, Kim-Fine S, Birch C, et al. Uterosacral vault suspension (USLS) at the time of hysterectomy: laparoscopic versus vaginal approach[J]. Int Urogynecol J, 2019,30(4):611-621. doi: 10.1007/s00192-018-3801-5. doi: 10.1007/s00192-018-3801-5 pmid: 30393822
[38]	Barber MD, Brubaker L, Nygaard I, et al. Pain and activity after vaginal reconstructive surgery for pelvic organ prolapse and stress urinary incontinence[J]. Am J Obstet Gynecol, 2019,221(3): 233.e1-e16. doi: 10.1016/j.ajog.2019.06.004. doi: 10.1016/j.ajog.2019.06.004