子宮全摘術後の腟断端脱に対する腹腔鏡下腟仙骨固定術の初期9例の経験

Abstract

子宮全摘術後の腟断端脱9例に対し, 腹腔鏡下に腟断端仙骨固定術を行った。術前の性器脱分類はglade 2:3例, glade 3:3例, grlade 4:3例であった。Trendenlenburg体位にし, polypropylen meshを腹腔内に挿入し, 症例によってはStraight-Inを使用した。術後, 前例で腟断端脱は消失した。手術時間は平均250分(180～358分), 出血量は平均80.7ml(0～200ml), 術後入院期間は平均8.3日(6～11日)であった。術中術後, 特に大きな合併症はみられなかった。術後平均観察期間7.8ヵ月現在, 再発症例は認められない。子宮全摘術後の腟断端脱に対する腹腔鏡下腟断端仙骨固定術は, 低侵襲手術として有用だと考えられた。

Laproscopic sacrocolpopexy offers a minimally invasive approach to correct post-hysterectomy vaginal vault prolapses. Herein we present our surgical technique and results. Through the transperitoneal approach, the retroperitoneal space was dissected along the right edge of the rectum and a polypropylene mesh is sutured to the vaginal apex and the anterior longitudinal ligament of the sacrum. We sutured the mesh to the sacrum with 2-0 PDS. To prevent bleeding from the pre-sacral vessels, occasionally we used a bone anchor system, Straight-In, in sacral fixation. Nine patients underwent this operation since August 19, 2005. The patient's age ranged from 48 to 78 years old. The median operation time was 250 minutes and the blood loss was 80.7 ml. The median post-operative hospital stay was 8.3 days. We experienced no peri- or post-operative complications. The vagina was well fixed post-operatively in all patients. Laparoscopic sacrocolpopexy is a minimally invasive treatment for vault prolapse and offers a high quality of life to patients.