%90宫骶骨韧带缩短固定术治疗子宫脱垂

・女性尿失禁研究・腹腔镜下子宫骶骨韧带缩短固定术

治疗子宫脱垂

梁志清　徐惠成　陈勇　熊光武　常青　张巧玉　何畏

【摘要】　目的　探讨腹腔镜下行子宫骶骨韧带缩短固定术治疗子宫脱垂的可行性及疗效。方法

　2001年2月至2003年5月间,采用腹腔镜下子宫骶骨韧带悬吊缩短固定术治疗子宫脱垂患者32

例。患者平均年龄5512岁(45～67岁),均为经产妇、绝经期妇女。32例均有子宫脱垂和阴道前壁膨

出,其中伴有阴道后壁膨出4例,合并有压力性尿失禁15例,合并子宫肌瘤4例。结果　32例患者

子宫或阴道残端固定手术均在腹腔镜下完成,手术时间平均为(32±11)min(20～80min),平均失血

量低于50ml(30～90ml)。随诊4～28个月,23例为治愈,7例为有效,2例术后复发。结论腹腔镜下

子宫骶骨韧带缩短固定术是一种治疗有症状的子宫脱垂的安全、有效的方法,特别适合希望保留子宫

的患者。

【关键词】　腹腔镜检查;　子宫脱垂;　骶骨;　韧带

Laparoscopic suture uterosacral ligament hysteropexy for uterine prolapse L IA N G Zhi2qing,XU Hui2

cheng,CHEN Yong,XION G Guang2w u,CHA N G Qing,ZHA N G Qiao2yu,HE Wei1Depart ment of

Obstet rics and Gynecology,Southwest Hospital,Third Military Medical U niversity,Chongqing400038,

China

【Abstract】　Objective　To investigate possibility and effect of laparoscopic suture uterosacral ligament

hysteropexy or colpopexy for women with uterine prolapse1Methods　Thirty2two women with

symptomatic uterine prolapse underwent laparoscopic suture uterosacral ligament hysteropexy1At the

laparoscopic suture hysteropexy or colpopexy,the pouch of Douglas was closed and the uterosacral ligaments

were plicated and reattached to the cervix1All patients were multipara and menopausal with prolapse of

anterior wall of vagina1Additionally,4patients were with prolapse of posterior wall of vagina,15with

stress urinary incontinence,and4with myomas1R esults　All procedures were successfully completed

laparoscopically1The mean operating time for the laparoscopic suture hysteropexy or colpopexy alone was

(32±11)min(range20～80min),and the mean blood loss was less than50ml1After a mean follow2up

of(12±6)months(range4～28months),23women had no symptoms of uterine prolapse and seven had

no objective evidence of uterine prolapse1Two women presented recurrence of uterine prolapse3months

after operation1Conclusions　The laparoscopy suture hysteropexy or colpopexy is effective and safe in the

management of symptomatic uterine prolapse1It may be an appropriate procedure for women with uterine

prolapse hoping for uterine preservation1

【K ey w ords】　Laparoscopy;　Uterine prolapse;　Sacrm;　Ligaments

子宫脱垂是妇女的常见病、多发病,严重危害妇女的身体健康及生活质量。治疗子宫脱垂的手术方法很多,目前,常用的方法包括阴式子宫切除、阴道前后壁修补、子宫悬吊等。其中子宫骶骨韧带悬吊术,近年来得到大多数患者的接受,其优点是能保持盆底支持结构的完整性及保留患者的子宫。而且,应用腹腔镜进行该手术,使创伤及痛苦更小,术后恢复快。我们自2001年开始,应用腹腔镜行子宫骶骨韧带缩短固定术治疗子宫脱垂,迄今已完成32例,近期临床效果满意,现报道如下。

资料与方法

一、研究对象

2001年2月至2003年5月期间,我们应用腹腔镜行子宫骶骨韧带缩短固定术治疗子宫脱垂患者32例,患者平均年龄5512岁(45～67岁)。32例均为经产妇,其中生育2胎8例,3胎15例,4胎9例。32例均为绝经妇女,未经规范的雌激素补充治疗,

作者单位:400038重庆,第三军医大学西南医院妇产科