【腹腔镜骶髋固定术:技术概述及标准化步骤】。

IF 0.9 4区 医学 Q3 MEDICINE, GENERAL & INTERNAL
Attila Gergely Sipos, Bence Kozma, Bálint Farkas, Zsolt Domján, Péter Takács, Zoárd Krasznai, Rudolf Lampé
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引用次数: 0

摘要

腹腔镜骶阴道固定术因其低复发率和微创手术的优点,已成为治疗根尖子宫阴道脱垂最常用的手术方法之一。手术技术有几种变化,其选择通常反映了外科医生的个人经验。然而,标准化手术步骤的好处是无可争议的,确保适当的适应和安全的执行程序。目的:本研究旨在结合已有文献和现有证据,介绍腹腔镜骶髋固定术在我们临床实践中的主要手术步骤,并对我们的临床资料进行分析。方法:根据相关文献、国际指南和我们的经验,将程序标准化为以下步骤:(1)手术野暴露,(2)峡部剥离,(3)直肠旁剥离,(4)直肠阴道剥离,(5)膀胱阴道剥离,(6)宫颈上子宫切除术(当指征和子宫体存在时,没有理由切除子宫颈),(7)阴道网片固定,(8)峡部网片固定,(9)腹膜闭合,(10)子宫体从腹腔取出。结果:我们分析了2022年9月至2023年4月在德布勒森大学妇产科进行的30例腹腔镜骶髋固定术的数据。术中、术后未发生重大并发症;有3例需要偏离计划手术类型。6周后,大多数患者报告主观脱垂症状明显改善。发现2例症状性复发:1例保守治疗,1例需要手术矫正。无新发应激性尿失禁病例。结论:腹腔镜骶阴道固定术可能是治疗根尖子宫阴道脱垂的有效手术选择。标准化手术步骤的应用可以提高手术安全性,促进手术培训,并有助于缩短手术时间。Orv Hetil. 2025;166(31): 1217 - 1223。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Laparoscopic sacrocolpopexy: technical overview and standardized steps].

Introduction: Due to its low recurrence rate and the advantages of minimally invasive surgery, laparoscopic sacrocolpopexy has become one of the most commonly performed procedures for the treatment of apical uterovaginal prolapse. Several variations of the surgical technique exist, with the choice often reflecting the surgeon’s individual experience. However, the benefits of standardized surgical steps are indisputable in ensuring proper adaptation and safe execution of the procedure. Objective:This study aims to present the main surgical steps of laparoscopic sacrocolpopexy as applied in our clinical practice, based on the available literature and current evidence, and to analyze our clinical data. Method: Following the relevant literature, international guidelines, and our experience, the procedure was standardized into the following steps: (1) exposure of the surgical field, (2) dissection of the promontory, (3) pararectal dissection, (4) rectovaginal dissection, (5) vesicovaginal dissection, (6) supracervical hysterectomy (when indicated and the uterine corpus is present, and removal of the cervix is not justified), (7) mesh fixation to the vagina, (8) mesh fixation to the promontory, (9) peritoneal closure, (10) removal of the uterine corpus from the abdominal cavity. Results: We analyzed data from 30 laparoscopic sacrocolpopexy procedures performed at the Department of Obstetrics and Gynecology, University of Debrecen, between September 2022 and April 2023. No major intraoperative or postoperative complications occurred; deviation from the planned surgical type was required in three cases. After 6 weeks, the majority of patients reported a marked improvement in subjective prolapse symptoms. Two cases of symptomatic recurrence were identified: one managed conservatively, and one required surgical correction. No cases of de novo stress urinary incontinence were observed. Conclusion: Laparoscopic sacrocolpopexy may represent an effective surgical option for the treatment of apical uterovaginal prolapse. The application of standardized surgical steps may improve procedural safety, facilitate surgical training, and contribute to reduced operative time. Orv Hetil. 2025; 166(31): 1217–1223.

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来源期刊
Orvosi hetilap
Orvosi hetilap MEDICINE, GENERAL & INTERNAL-
CiteScore
1.20
自引率
50.00%
发文量
274
期刊介绍: The journal publishes original and review papers in the fields of experimental and clinical medicine. It covers epidemiology, diagnostics, therapy and the prevention of human diseases as well as papers of medical history. Orvosi Hetilap is the oldest, still in-print, Hungarian publication and also the one-and-only weekly published scientific journal in Hungary. The strategy of the journal is based on the Curatorium of the Lajos Markusovszky Foundation and on the National and International Editorial Board. The 150 year-old journal is part of the Hungarian Cultural Heritage.
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