盆底器官脱垂 Pelvic Organ Prolapse.ppt

Aim of surgery is to relieve or improve prolapse symptoms Symptoms associated with the lower urinary and gastrointestinal tracts. In some women, this means an attempt to restore normal vaginal anatomy and maintain or improve sexual function. In others, an obliterative approach is more appropriate and still yields the desired result of symptom relief. Vaginal surgery Decreased operative time Decreased incidence of adhesion formation Quicker recovery time Abdominal surgery. Failed previous vaginal approach Have foreshortened vagina With other co existing conditions Obliterative procedures Vaginal hysterectomy Anterior repair, paravaginal repair for cystocele Posterior repair for rectocele Sacrospinous ligament fixation High uterosacral ligament suspension with fascial reconstruction Iliococcygeus fascia suspension Abdominal sacral colpopexy High uterosacral ligament suspension Laparoscopic approach * The best choice is the first choice The first choice is the best choice * Pelvic Organ Prolapse Pelvic organ prolapse(POP) is a common group of clinical conditions affecting millions of women Including Anterior and posterior vaginal prolapse Uterine prolapse Enterocele The prevalence of POP increases with age The lifetime risk that a woman in the USA will have surgery for POP or urinary incontinence is 11%, with up to 1/3 of surgeries representing repeat procedures. The direct cost of prolapse surgery is greater than $1 billion per year The upper third of the vagina (level I) is suspended from the pelvic walls by vertical fibers of the paracolpium, which is a continuation of the cardinal ligament. In the middle third of the vagina (level II) the paracolpium attaches the vagina laterally to the arcus tendineus and fascia of the levator ani muscles. The vaginas lower third fuses with the perineal membrane, levator ani muscles, and perineal body (level III). LEVEL 1 LEVEL 2 LEVEL 3 第一水平：骶－主韧带复合体悬吊支持子宫，阴道（顶端悬吊支持）上1/3。 第二水平：直肠阴道筋膜、耻骨宫颈筋膜向两侧与（侧方水平支持）盆筋膜腱