吕超霞 张文举 张伟丽

[摘要] 子宫/穹隆脱垂是盆腔器官脱垂（Pelvic organ prolapse，POP）中的常见类型，手术是治疗重度POP的首选方法。若术中修复不到位会增加手术后复发率。腹腔镜的应用使手术更微创，网片的应用有利于生理解剖结构的重建，两者联合应用，有效的降低了术后复发率。目前，治疗中盆腔器官脱垂的金标准术式为骶骨固定术，但此手术不易掌握，常出现术后排便障碍等并发症，腹腔镜下髂耻韧带悬吊术具有操作简单、并发症少，术后满意度高、复发率低，能够恢复患者盆底生理解剖结构等优势。但作为一种新术式，其开展时间短，缺乏多中心、前瞻性的随机对照试验。本文对该术式的国内外临床研究进展予以综述。

[关键词] 盆腔器官脱垂;骶骨固定术;髂耻韧带悬吊术;临床研究进展

[中图分类号] R713.4          [文献标识码] A          [文章编号] 1673-9701（2020）31-0185-04

[Abstract] Uterine/fornix prolapse is a common type of pelvic organ prolapse（POP）. Surgery is the first choice to treat severe POP. If the repair is not in place during surgery， it will increase the recurrence rate after surgery. The application of laparoscopy makes the operation more minimally invasive， and the application of mesh is conducive to the reconstruction of physiological anatomy. The combined application of the two effectively reduces the recurrence rate after surgery. At present， the gold standard procedure for the treatment of prolapse of the pelvic organs is sacral fixation， but this operation is not easy to master， and complications such as postoperative bowel disorders often occur. Laparoscopic pectopexy has simple operation and few complications， high postoperative satisfaction， low recurrence rate. And it can restore the patient's pelvic floor physiological anatomy and other advantages. However， as a new procedure， its development time is short， and there is a lack of multi-center， prospective randomized controlled trials. This article reviews the clinical research progress of this procedure at home and abroad.

[Key words] Pelvic organ prolapse; Sacral colpopexy; Pectopexy; Clinical research progress

盆腔器官脫垂（Pelvic organ prolapse，POP）是由各种因素导致盆底支撑结构变弱，造成盆腔器官的位置及功能异常的一类疾病。POP包括前、中、后盆腔器官脱垂，中盆腔器官脱垂是指子宫脱垂或子宫切除术后的阴道穹隆脱垂，可伴有排尿或排便障碍[1]。随着全球老龄化的加剧，未来30年，POP的患病率明显增加，导致其相应的医疗费用增加、社会负担加重[2]。对于重度POP，通过手术以实现解剖和功能重建是治疗该病的首选方法[3]。有研究显示，女性一生中接受盆腔器官脱垂手术的风险为10%～20%[4]。顶端的修复是POP修复手术的重要环节[5]。目前常用的手术方式主要有骶骨固定术、高位骶韧带缩短固定术、子宫圆韧带缩短术和骶棘韧带悬吊术等[6-7]。……