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Objective:To study the clinical effect of sacrospinous ligament fixation (SSLF) and traditional vaginal hysterectomy on pelvic organ prolapse (POP) .Methods:A retrospective analysis was performed on 68 patients with POP of degree II-IV admittedl from Jan. 2017 to Dec. 2019. Among them, 33 patients were treated with SSLF (observation group) and 35 patients were treated with vaginal total hysterectomy (control group). Intraoperative blood loss, operative time, postoperative indwelling catheter and average length of hospital stay were compared between the two groups. The patients were followed up for 6 months, and the scores of pelvic floor dysfunction questionnaire-20 (PFDI-20) and sexual quality questionnaire -12 (PISQ-12) were used to evaluate the subjective satisfaction degree of postoperative recovery.Results:In the observation group, the intraoperative blood loss (173.94±52.14) ml, postoperative indurating catheter time (2.72±0.45) d and average length of hospital stay (7.09±0.63) d were observed. There were statistically significant differences in intraoperative blood loss (228.86±53.40) ml, postoperative induration time (4.54±0.61) d and mean hospital stay (9.22±0.81) d in the control group ( P<0.05). There was no significant difference in the operation time between the observation group (99.57±9.50) min and the control group (101.06±8.64) min, ( P>0.05). The improvement of PFDI-20 and PISQ-12 in both groups was significant before and after treatment. The PISQ-12 score of the observation group was higher than that of the control group 6 months after surgery, and the difference was statistically significant ( P <0. 05). There was no significant difference in PFDI-20 score between the two groups ( P>0.05). There was statistical significance in the positions of pop-Q indicators in the two surgical methods ( P < 0.05) . Conclusions:SSLF with uterus preservation and total vaginal hysterectomy are both effective in treatment of moderate and severe POP. However, SSLF with uterus preservation has less intraoperative blood loss, and the postoperative recovery is significantly better than that with total vaginal hysterectomy. In addition, it satisfies patients’ desire to preserve uterus, improves the postoperative sexual life quality, which is worthy of promotion.
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OBJECTIVE: Use cadavers and three-dimensional MRA models to study the anatomical relationship between the sacrospinous ligament(SSL)and its adjacent vessels and nerves.METHODS: Totally 24 female cadavers provided by Anatomy Department of Southern Medical University from September 2017 to September 2018 were dissected,and 30 MRA data collected by Gynecology Department of Nanfang Hospital of Southern Medical University from January 2015 to December 2018 were selected to reconstruct to measure the relevant application parameters.RESULTS: The medial structure of the pudendal canal was the pudendal nerve,and the horizontal distance between the right pudendal nerve and the sciatic spine was(1.51 ± 0.35)cm. The thickness of the thickest point of the right coccygeus-sacrospinousligament(CSSL)was(1.03±0.23)cm and the horizontal distance between the point and the right sciatic spine was(2.81±0.55)cm;the vertical distance from where the right inferior gluteal artery is out of pelvis cavity to the horizontal line of sciatic spine was(2.43±0.95)cm,and the distance between the vertical point and the sciatic spine was(1.83±0.83)cm. In anatomy and MRA model,none of the inferior gluteal artery went dorsally through the SSL,and the sciatic nerve was away from the SSL.There was no obvious vascular nerve traveling on the pelvic surface of SSL.CONCLUSION: The point which is 2.81 cm away from the right sciatic spine of the SSL at the horizonal level may be the best suspension point for SSLF.
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Objective To investigate the value of evaluation of pelvic floor ultrasound in the transvaginal modified patch repair and sacrospinous ligament fixation in uterine prolapse patients. Methods Thirty-two patients with uterine prolapse were included in the retrospective study from March 2016 to January 2017 in Hangzhou maternity and child health care hospital. All patients were detected by pelvic floor ultrasound before operation and cured by vaginal patch bilateral sacral spine ligament fixation treatment after. Of them, 8 cases were complicated with cystocele and 3 cases with anorectal prolapse, and all the complications were treated at the same time. The observations of the change of position, shape and activity of the implant by transvaginal at rest, on maxium Valsalva and contraction, and the transperineal pelvic ultrasound were performed to evaluate the change of pelvic floor function and compare the distance from the lowest point of the bladder, uterus and the rectal ampulla to reference line (the horizontal line at the lower margin of the pubic bone), area of levator hiatus and the thickness of the puborectalis muscle before and after operation. Results The patches were observed 2D and 3D postoperatively by pelvic ultrasound. The U-shaped hyperecho could be clearly shown around the cervix and activity of patches were clearly shown. The observation of 32 cases of patients with pelvic viscera situation by the transperineal 2D and 4D pelvic ultrasound: the distance from the lowest point of the bladder, uterus and the rectal ampulla to reference line and the thickness of the puborectalis muscle enlarged after operation (0.65±1.85 vs 0.15±1.85, 2.80±1.10 vs -1.00±1.50, 0.60±1.90 vs-0.55±1.55,0.51±0.24 vs 0.37±0.19)onmaxium valsalva,the area of levator hiatus decreased after operation (20.15±7.20 vs 29.00±9.50).The differences were both statistically significant (all P < 0.05). Uterine prolapse were not found after operation. In the 8 cases with cystocele, 5 cases were cured and 3 cases were improved. And all the 3 cases of patients with anorectal prolapse were all cured. Conclusion Combined application of transvaginal and transperineal pelvic ultrasound can clearly show the suspension of the patch after the treatment of modified patch repair and Sacrospinous ligament fixation, which provide valuable imaging information in the evaluation of preoperative pelvic functionand postoperative therapeutic effect.
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Objective To explore the clinical efficacy and surgical techniques of vaginal sacrospinous ligament fixation,which was used for treatment of uterine prolapse and vaginal prolapse of the top.Methods 25 patients with uterine prolapse and vaginal vault prolapse were treated with VSSLF,and its feasibility and effiency was analyzed.Results All patients were successfully conducted the surgical indexing method based on POP-Q,25 cases of uterine prolapse,vaginal anterior and posterior wall prolapse and urinary incontinence and other symptoms all had been corrected.There was no intraoperative and postoperative bleeding or pelvic organ injury in surgry.25 patients recovered well after operation,postoperative morbidity,not observed in other complications associated with surgery.All the patients were followed up for 24 months,patients'cervix 4 cm from the hymen edge,related symptoms disappeared or improved significantly.Conclusion Vaginal sacrospinous ligament fixation is a safe,simple,effective and minimally invasive surgery for uterine prolapse and vaginal prolapse of the top.
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Objective To discuss the clinical value of the suture of sacral ligament and pubovaginalis fascia plus sacrospinous ligament fixation in the treatment of moderate and severe pelvic organ prolapse ( POP) . Methods Thirty-two cases with moderate or severe POP,who were treated by the suture of sacral ligament and pubovaginalis fascia besides sacrospinous ligament fixation,were retrospectively analyzed. Results The locations of POP in the 32 patients were mainly in the anterior and middle pelvis cavity. The degree of uterine prolapse was not less than POP-Q Ⅲ phase. The anterior and/or posterior vaginal walls were also prolapsed. The patients were treated by the transvaginal panhysterectomy,vaginal wall neoplasty,sacrospinous ligament fixation and the suture of sacral ligament and pubovaginalis fascia. Those with stress incontinence were also treated with urethral posterior ligament plication. The operation time was 60~120 min,and the hemorrhage vol-ume was 100~300 mL. There were no severe complications or recurrence in all patients. Conclusion The suture of sacral ligament and pubovaginalis fascia could greatly reduce the hazard rate of the recurrence of anterior pelvic organ defects in POP patients treated by sacrospi-nous ligament fixation. The suture operation could strengthen the anterior pelvis cavity,and was proven to be simple,secure and effective. Therefore,the operation is valuable to be used in clinical application.
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Objective To investigate the effect of bilateral sacrospinous ligament fixation by Pavlik harness method in the treatment of pelvic organ prolapse (POP). Methods Sixty patients with POP received operation were divided into bilateral sacrospinous ligament fixation by Pavlik harness method group (study group,30 cases),posterior intravaginal sling plasty group (P-IVS group, 15 cases) and sacrospinous ligament fixation group (SSLF group, 15 cases) by random digits table. The data of the three groups, such as operation time, bleeding during the operation, indwelling urinary catheter time, duration out of bed after operation, cure rate, recurrence rate and the quality of sexual life were observed. Results The operation time in study group [( 30.5 ± 5.3 ) min] was significantly shorter than that in SSLF group [(43.5 ± 10.6) min](P ＜ 0.05 ), and the duration out of bed in study group [( 1.5 ± 0.6) d] was earlier than that in SSLF group [(3.1 ±0.7) d] and P-IVS group [(3.3 ±0.8) d](P＜0.05). The POP-Q stage of all the patients being hospital was 0 or Ⅰ , approached the cure standard. Patients were followed up for 3-16 months after operation, the recurrence rate and the decrease of the quality of sexual life in study group [0,3.3%(1/30)]were lower than those in P-IVS group [20.0%(3/15),13.3%(2/15)] and SSLF group[6.7%(1/15),26.7%(4/15)] (P ＜ 0.05). Conclusion Bilateral sacrospinous ligament fixation by Pavlik harness method is a simple, firm operation, and the position of vagina does not axialitily change and suits the anatomy, so it is effective and worth spreading clinically to treat the POP.