골반장기탈출증에 대한 자궁천골인대 질원개고정술과 항문거근봉합술의 효용성과 안전성에 관한 연구
EFFICACY AND SAFETY OF UTEROSACRAL LIGAMENT VAGINAL VAULT SUSPENSION AND LEVATOR MYORRHAPHY FOR PELVIC ORGAN PROLAPSE
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초록
목적골반장기탈출증의 치료로 시행된 자궁천골인대고정술및 항문거근봉합술의 안전성과 시술 후 해부학적 그리고 기능학적 결과의 효용성에관하여 평가하고자 한다. 연구방법Pelvic organ prolapse quantification 체계를 이용하여 골반장기탈출증으로 진단받고 질식자궁절제술, 자궁천골인대고정술, 항문거근봉합술을 시행받은 28예의 의무기록을 조사하였다. 대상환자들은 수술 전 그리고 후에 요로계, 장관계, 골반증상 및 성기능 증상에 한글판 pelvic floor distress inventory와 pelvic organ prolapse and incontinence sexual questionnaire를 작성하였다. 결과수술 전 평균 3기의 탈줄증이 수술 후 0기로 탈출증의 정도가 의미 있게 교정되었다. Ba, C, Bp 점은 각각 수술 전 3.7 ± 1.5, 2.5 ± 1.2,-0.1 ± 2.5이었으나, 수술 후 각각 -2.7 ± 0.4, -6.2 ± 0.9, -2.1 ± 2.3으로 교정되었다. 수술 중 2예에서 요관폐색이 발생하였고 수술 후요로감염 2예, 배뇨장애 3예, 요실금 1예가 발생하였다. 결론골반장기탈출증 수술에서 질원개 고정을 위한 자궁천골인대고정술및 항문거근봉합술은 안전하고 효용성이 높은 수술로 생각된다.
Abstract
Objective To evaluate the effi cacy in the anatomical and functional outcome and the safety of uterosacral vaginal vault suspension and levator myorrhaphy surgery performed during vaginal hysterectomy for pelvic organ prolapse. Methods A retrospective analysis was performed on the medical records of twenty-eight patients who underwent uterosacral vaginal vault suspension and levator myorrhaphy with the vaginal hysterectomy for pelvic organ prolapse. Anatomical outcomes based on pelvic organ prolapse quantifi cation (POP-Q) system and urinary, bowel and sexual symptoms from Korean version of short form of pelvic fl oor distress inventory and pelvic organ prolapse and incontinence sexual questionnaire were assessed pre- and postoperatively. They were followed up for minimum a year. The recurrence was defi ned as any points of POP-Q system to be stage II or greater. Results A signifi cant improvement of prolapse was observed from preoperative stage of III to postoperative stage of 0. The points of Ba,C, Bp were changed from 3.7 ± 1.5, 2.5 ± 1.2, -0.1 ± 2.5 to -2.7 ± 0.4, -6.2 ± 0.9, -2.1 ± 2.3. Intra-operative complications were 2cases of ureter injury while stitching from uterosacral vaginal vault suspension surgery. Post-operative complications were 2 cases of urinary tract infection, 3 cases of voiding dysfunction and a case of urinary incontinence. No patient required reoperation for recurrent prolapse and urinary incontinence. Conclusion Based on our operational result, uterosacral vaginal vault suspension and levator myorrhaphy surgery seem to provide safe and effective outcomes.
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