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學 術
12 2009, Vol.52, No.1
要討論子宮切除後陰道壁脫垂的治療問題,可先回溯
在數年前,當病人在接受子宮切除後,醫師是否有合併做
陰道壁懸吊 (cuff suspension) 或者是 McCall culdoplasty
,也就是把陰道斷端 (vaginal cuff) 和主韌帶-子宮薦骨韌
帶複合體 (cardinal uterosacral ligament complex) 縫在一
起,如此一來可加強對骨盆內筋膜 (endopelvic fascia) 的
牽引作用,進而減輕病人應力性尿失禁的程度(1),也可減
少日後發生陰道壁頂端 (vault prolapse) 的機會。
子宮切除後陰道壁脫垂的發生率在 0.2% - 43%,
而不管是經腹部或經陰道切除後的發生比率是差不多
的(2)。我們知道支持子宮頸最重要的兩條韌帶就是主
(cardinal)韌帶與子宮薦骨 (uterosacral) 韌帶,而由坐骨
棘 (ischial spine) 到恥骨後下緣,延伸出兩條弓狀韌帶,像
左右兩支擔架,中間便是恥骨子宮頸筋膜 (pubocervical
fascia) (圖1),上面就躺著膀胱。在陰道和直腸間的中隔
就是直腸陰道中隔(rectovaginal septum),這都算是骨盆
內筋膜 (endopelvic fascia)的一部份。所以pubocervical
fascia ,cardinal & uterosacral ligament及rectovaginal
7. Fa rn swo r th BN : Pos te rio r in t ravaginal slingplas t y(infracoccygealsacropexy)forsevereposthysterectomyvaginalvaultprolapse--apreliminaryreportonefficacyandsafety.IntUrogynecolJPelvicFloorDysfunct2002;13:4-8.
8. OuCS:Complicationsassociatedwiththeapogeeandperigeemethod to correct cystoceleand rectocele -our experience.27th Annual ScientificMeeting of the AUGS-AmericanUrolgynecologicSociety,PalmSprings,CA,Oct19-21,2006.
9. LongCY,HsuCS,LoTS,etal.:Ultrasonographicassessmentof tape location following tension-free vaginal tape and