전 자궁탈출증 환자에서 질식 자궁절제술 및 복강경 보조 질식 천골질고정술

Abstract

The purpose of this study was to evaluate the effectiveness of laparoscopy assisted transvaginal sacrocolpopexy. This study was designed as a clinical analysis of 19 patients with total uterine prolapse who underwent total vaginal hysterectomy (TVH) with laparoscopy assisted transvaginal sacrocolpopexy using Prolene mesh. The materials were selected among the patients who had total uterine prolapse from Sep. 2006 to Feb. 2009 in Chosun University Hospital. Pelvic organ prolapse was diagnosed by using the Pelvic Organ Prolapse Quantification (POP-Q) staging system. TVH was performed by traditional method. Prolene mesh, fashioned in a Y configuration, is affixed to the anterior and posterior vaginal wall via transvaginal approach. The other side of the mesh was attached to the anterior longitudinal ligament of the sacral promontary via laparoscopic approach. Surgical outcomes were determined by Postoperative Quality of Life (P-QOL) questionnaire and pelvic examination. Wilcoxon signed ranks test was used in statistical analysis. Mean age was 61.8 years (47-78). Mean follow up period was 22.9 months (1-30). Preexisting urinary incontinence improved in 2 cases after operation. De novo urinary incontinence occured in 1 case after operation. P-QOL score is lower postoperation than preoperation in all patients. A high total score indicates a greater impairment of quality of life, while a low total score indicates a good quality of life. Postoperative POP-Q stage was I in all cases. In spite of short follow up period (22.9 months), we suggest that TVH with laparoscopy assisted transvaginal sacrocolpopexy is easy, reproducible surgical method with good anatomic results of the patients with total uterine prolapse.