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腹腔镜下燕尾服式骶骨固定术4例报道
Laparoscopic sacrum fixation with swallow-tailed mesh: a report of 4 cases
- 重庆医科大学学报 2022年47卷第5期 页码：538-542
- 作者机构：
重庆市妇幼保健院妇科盆底与肿瘤科，重庆 400021
- 作者简介：
赵成志，Email：chengzi_555@qq.com，研究方向：妇科盆底与泌尿、妇科肿瘤与微创。
刘禄斌，Email：liulubin1975@126.com。
- 基金信息：重庆市自然科学基金资助项目(cstc2019jcyj-msxm 0877);重庆市技术创新与应用示范（社会民生类一般）资助项目(cstc2018jscx-msyb0800)
DOI：10.13406/j.cnki.cyxb.002660
中图分类号： R711.74纸质出版日期：2022-05-28，
收稿日期：2020-05-09，
扫 描 看 全 文
赵成志, 卢深涛, 王荥, 等. 腹腔镜下燕尾服式骶骨固定术4例报道[J]. 重庆医科大学学报, 2022,47(5):538-542.
Chengzhi Zhao, Shentao Lu, Ying Wang, et al. Laparoscopic sacrum fixation with swallow-tailed mesh: a report of 4 cases[J]. Journal of Shanxi Agricultural Sciences, 2022,47(5):538-542.
赵成志, 卢深涛, 王荥, 等. 腹腔镜下燕尾服式骶骨固定术4例报道[J]. 重庆医科大学学报, 2022,47(5):538-542. DOI： 10.13406/j.cnki.cyxb.002660.
Chengzhi Zhao, Shentao Lu, Ying Wang, et al. Laparoscopic sacrum fixation with swallow-tailed mesh: a report of 4 cases[J]. Journal of Shanxi Agricultural Sciences, 2022,47(5):538-542. DOI： 10.13406/j.cnki.cyxb.002660.
摘要
目的：
2
探讨燕尾服式骶骨固定术式治疗中盆腔和（或）合并后盆腔缺陷的可行性及临床疗效。
方法：
2
回顾性分析2019年重庆市妇幼保健院采用燕尾服式骶骨固定术治疗中盆腔和（或）合并后盆腔缺陷的4例患者临床资料，本研究使用自裁的网片和自行设计的穿刺锥完成手术。
结果：
2
4例患者均诊断为中盆腔合并后盆腔缺陷，其中3例为子宫脱垂伴阴道后壁膨出，1例为穹窿脱垂伴肠疝患者；4例患者均接受燕尾服式骶骨固定术并成功完成手术，无辅助阴式修补和中转开腹病例，术中无肠管等器官损伤的并发症发生。手术平均时间166 min，术中平均出血量为68 mL。所有患者在术后5~6 d均顺利出院，随访中超声提示盆腔脏器位置正常，网片覆盖平整，直肠阴道检查网片平铺无张力，且阴道后壁柔软无膨出。
结论：
2
燕尾服式骶骨固定术可以在修复和加强Ⅰ水平缺陷的同时修复加强Ⅱ、Ⅲ水平缺陷，是治疗中盆腔缺陷、中盆腔合并后盆腔的有效方法，也适用于后盆腔缺陷疾病的诊治。
Abstract
Objective
:
2
To explore the feasibility and clinical effect of laparoscopic sacrum fixation with swallow-tailed mesh in the treatment of middle and/or combined posterior pelvic cavity defects.
Methods
:
2
The clinical data of 4 patients with middle and/or combined posterior pelvic cavity defects treated by laparoscopic sacrum fixation with swallow-tailed mesh in Chongqing Health Center for Women and Children in 2019 were analyzed retrospectively. In this study
self-made mesh and self-designed puncture cone were used to complete the operation.
Results
:
2
Four patients were diagnosed as middle pelvic cavity combined with posterior pelvic defects
including 3 cases of uterine prolapse with vaginal posterior wall expansion
and 1 case of vaginal vault prolapse with enterocele. All patients received swallow-tailed sacrum fixation and successfully suffered from the operation
without auxiliary vaginal repairment and conversion to open abdomen
and no complications of intestinal tube and other organ damage during the operation. The average time of operation was 166 min
and the average amount of bleeding was 68 mL. All the patients were discharged smoothly 5-6 days after operation. According to the follow-up
ultrasound showed that the pelvic organs were in normal position
the mesh coverage was flat
the rectal and vaginal examination mesh was flat without tension
and the posterior wall of the vagina was soft without swelling.
Conclusion
:
2
The swallow-tailed sacrum fixation can repair and strengthen the levelⅠdefects as well as the levelⅡandⅢdefects
which is an effective method for the treatment of the middle pelvic cavity defects and the combination of the middle and the posterior pelvic cavity defects
and is also suitable for the diagnosis and treatment of the posterior pelvic cavity defects.
关键词
腹腔镜“燕尾服式”网片子宫脱垂后盆腔缺陷个体化术式
Keywords
laparoscopyswallow-tailed meshuterine prolapseposterior pelvic cavity defectindividualized operation
references
Nygaard IE, McCreery R, Brubaker L, et al. Abdominal sacrocolpopexy: a comprehensive review[J]. Obstet Gynecol, 2004, 104(4): 805-823.
Florian-Rodriguez ME, Hamner JJ, Corton MM. First sacral nerve and anterior longitudinal ligament anatomy: clinical applications during sacrocolpopexy[J]. Am J Obstet Gynecol, 2017, 217(5): 607.e1-607.e4.
Baessler K, Schuessler B. Abdominal sacrocolpopexy and anatomy and function of the posterior compartment[J]. Obstet Gynecol, 2001, 97(5 Pt 1): 678-684.
Brubaker L. Sacrocolpopexy and the anterior compartment: support and function[J]. Am J Obstet Gynecol, 1995, 173(6): 1690-1695.
Lizee D, Campagna G, Morciano A, et al. Laparoscopic sacral colpopexy: how to place the posterior mesh into rectovaginal space?[J]. Neurourol Urodyn, 2017, 36(6): 1529-1534.
Wong V, Guzman Rojas R, Shek KL, et al. Laparoscopic sacrocolpopexy: how low does the mesh go?[J]. Ultrasound Obstet Gynecol, 2017, 49(3): 404-408.
赵成志, 孙玉菡, 卢深涛, 等. 腹腔镜下自裁Artisyn-Y型网片同时纠正中盆腔及后盆腔缺陷的术式报道[J]. 国际妇产科学杂志, 2019, 46(4): 392-393.
Zhao CZ, Sun YH, Lu ST, et al. Laparoscopic self-tailoring artisyn-Y mesh for simultaneous correction of middle and posterior pelvic defects[J]. J Int Obstet Gynecol, 2019, 46(4): 392-393.
Antiphon P, Elard S, Benyoussef A, et al. Laparoscopic promontory sacral colpopexy: is the posterior, recto-vaginal, mesh mandatory?[J]. Eur Urol, 2004, 45(5): 655-661.
Morciano A, Marzo G, Caliandro D, et al. Laparoscopic sacral colpopexy and a new approach to mesh fixation: a randomized clinical trial[J]. Arch Gynecol Obstet, 2018, 298(5): 939-944.
Ercoli A, Campagna G, Delmas V, et al. Anatomical insights into sacrocolpopexy for multicompartment pelvic organ prolapse[J]. Neurourol Urodyn, 2016, 35(7): 813-818.
Arthure HG, Savage D. Uterine prolapse and prolapse of the vaginal vault treated by sacral hysteropexy[J]. J Obstet Gynaecol Br Emp, 1957, 64(3): 355-360.
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