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世界核心医学期刊文摘（妇产科学分册） 2006年第9期2卷 21-22页

作者： jelovsek j.e. Barber M.D. 柳蕴 Division of Urogynecology and Pelvic Reconstructive Surgery Department of Gynecology and Obstetrics The Cleveland Clinic Foundation Cleveland OH United States Dr

Objective: Women who seek treatment for pelvic organ prolapse strive for an improvement in quality of life. Body image has been shown to be an important component of differences in quality of life. To date, there are no data on body image in patients with advanced pelvic organ prolapse. Our objective was to compare body image and quality of life in women with advanced pelvic organ prolapse with normal controls. Studydesign: We used a case-control study design. Cases were defined as subjects who presented to a tertiary urogynecology clinic with advanced pelvic organ prolapse (stage 3 or 4). Controls were defined as subjects who presented to a tertiary care gynecology or women s health clinic for an annual visit with normal pelvic floor support (stage 0 or 1) and without urinary incontinence. All patients completed a valid and reliable bodyimage scale and a generalized (Short Form Health Survey) and condition-specific (Pelvic Floor Distress Inventory- 20) quality- of- life scale. Linear and logistic regression analyses were performed to adjust for possible confounding variables. Results:Forty-seven case and 51 control subjects were *** controlling for age, race, parity, previous hysterectomy,and medical comorbidities, subjects with advanced pelvic organ prolapse were more likely to feel self-conscious (adjusted oddsratio 4.7; 95% confidence interval 1.4 to 18, P = .02), less likely to feel physically attractive (adjusted odds ratio 11; 95% confidence interval 2.9 to 51, P ess likely to feel feminine(adjusted odds ratio 4.0; 95% confidence interval 1.2 to 15, P = .03), and less likely to feel sexually attractive (adjusted odds ratio 4.6; 95% confidence interval 1.4 to 17, P = .02) than normal controls. The groups were similar in their feeling of dissatisfaction with appearance when dressed, difficulty looking at themselves naked, avoiding people because of appearance, and overall dissatisfaction with their body. Subjects with advanced pelvic organ

关键词：盆腔脏器脱垂患者生活质量正常妇女体型重度治疗 logistic回归分析盆底功能失调

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盆腔器官脱垂阴式手术时输尿管梗阻的发生率及术中膀胱镜的应用价值

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世界核心医学期刊文摘（妇产科学分册） 2006年第9期2卷 31-31页

作者： Gustilo-Ashby A.M. jelovsek j.e. Barber M.D. 吕涛 Division of Urogynecology and Reconstructive Pelvic Surgery Department of Obstetrics and Gynecology The Clevel and Clinic Foundation Cleveland OH United States Dr

Objective: The objective of the study was to determine the incidence of ureteral obstruction during vaginal surgery for pelvic organ prolapse and the accuracy and efficacy of intraoperative cystoscopy. Study design: The study was a retrospective review of 700 consecutive patients who underwent vaginal surgery for anterior and/or apical pelvic organ prolapse with universal intraoperative cystoscopy. Results: Thirty-seven patients (5.3% ) had no spillage of dye from 1 or both ureters intraoperatively. The false-positive and negative cystoscopy rates were 0.4% and 0.3% , respectively. Thus, the true incidence of intraoperative ureteral obstruction was 5.1% . Intraoperative cystoscopy was accurate in 99.3% of cases, with a sensitivity and specificity of 94.4% and 99.5% , respectively. Suture removal relieved ureteral obstruction in 88% of cases. Six subjects (0.9% ) had true ureteral injuries. Conclusion: Vaginal surgery for anterior and/or apical pelvic organ prolapse is associated with an intraoperative ureteral obstruction rate of 5.1% . Intraoperative cystoscopy accurately detects ureteral obstruction and allows for relief of obstruction in the majority of cases.

关键词：盆腔器官脱垂输尿管梗阻膀胱镜检查手术中发生率手术时阴式价值

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盆腔器官脱垂和尿失禁患者发生的功能性肠病和肛门直肠功能紊乱

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世界核心医学期刊文摘（妇产科学分册） 2006年第5期2卷 6-7页

作者： jelovsek j.e.Barber M.D Paraiso M.F.R Walters M.D. 李奎 Cleveland Clinic Foundation Department of Gynecology and Obstetrics 9500 Euclid Avenue/A81 Cleveland OH 44195 United States

The purpose of this study was 1) to determine the prevalence of functional bowel and anorectal disorders as defined by the Rome Ⅱ criteria in patients with advanced pelvic organ prolapse (POP) and urinary incontinence (UI), and (2) to determine if the extent of prolapse on gynecologic examination is related to the subtypes of constipation or any functional anorectal pain disorder. Study design: Three hundred and two consecutive female subjects presenting to a tertiary urogynecology clinic were enrolled. Demographic, general medical, and physical examination information, including POPQ measurements and a standardized sacral neurologic evaluation, were collected. The prevalence of functional disorders of the bowel, rectum, and anus as defined by the Rome Ⅱ criteria were collected using the Rome Ⅱ Modular questionnaire. Relationships of functional disorders to various components of the vaginal examination were reviewed. Results: Thirty six percent (108/302) met the criteria for constipation, including the following subtypes: 19% outlet constipation, 5% functional constipation, 5% constipation predominant irritable bowel syndrome (IBS), and 7% IBS outlet. Nineteen percent (56/302) of subjects had IBS or 1 of its subtypes. Functional diarrhea was seen in 6% (17/302), fecal incontinence in 19% (58/302), and anorectal pain disorders in 25% (77/302). After controlling for age, parity, diabetes, constipating medications, and previous pelvic surgery, there were no differences in the prevalence of constipation or any of its subtypes between patients with UI and those with stage 3 or 4 POP. Fecal incontinence was independently associated with UI (adjusted odds ratio[OR] 6.3; 95% CI 2.6- 19.1), but not advanced POP. Neither overall stage of POP nor stage of posterior vaginal prolapse was significantly associated with any of the functional bowel disorders, including constipation and its subtypes. Perineal body measurement was significantly longer in patients with outlet type co

关键词：盆腔器官脱垂功能性肠病肛门直肠阴道后壁膨出罗马Ⅱ标准盆腔手术史痉挛性肛部痛统计学资料

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尾骨下骶韧带固定术(经阴道后路悬吊术)套管针穿刺路径周围的解剖关系

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世界核心医学期刊文摘（妇产科学分册） 2006年第5期2卷 6-6页

作者： jelovsek j.e.Sokol A.I Barber M.D 李奎 Cleveland Clinic Foundation Department of Gynecology and Obstetrics 9500 Euclid Avenue/A81 Cleveland OH 44195 United States

The purpose of this study was to describe the distances of the major bony, vascular, neurologic, and visceral structures to the path of the infracoccygeal sacropexy trocar and to determine the point of trocar entry into the vagina. Study design: Infracoccygeal sacropexy trocars were inserted bilaterally into 6 fresh frozen cadavers. Dissection was performed and the maximal length of the vagina, ischiorectal fossa, and pararectal spaces were measured bilaterally. Mean distances with 95% CIs to important anatomic structures were made from fixed points along the trocar s path. Results: The path of the trocar began dorsal and lateral to the anus, passed through the ischiorectal fossa, iliococcygeus muscle, into the pararectal space, and into the posteriolateral vagina. Along this course, the mean distance (95% CI) to the pudendal vessels at the exit of Alcock s canal was 2.8 cm (2.1 to 3.4 cm) and rectum was 0.5 cm (0.2 to 0.9 cm). The closest inferior rectal vessel was 0.1 cm (0 to 0.3 cm). In the pararectal space, the mean distance to the ischial spine was 2.6 cm (1.7 to 3.5 cm). In 12 of 12 trocar passages, the inferior rectal branches of the pudendal artery and the rectum were within 1 cm or less of the trocar. The mean distance of trocar entry into the vagina was only 4.8 cm (4.3 to 5.4 cm) proximal to the hymenal ring compared with a mean total vaginal length of 8.7 cm (8.0 to 9.3 cm). Conclusion: This anatomic study suggests that the rectum and the inferior rectal branches of the pudendal neurovascular bundle may be at risk of injury during infracoccygeal sacropexy trocar placement. Additionally, this procedure appears to provide support to the mid posterior vaginal wall, not the vaginal apex.

关键词：韧带固定术穿刺路径髂尾肌侧阴道坐骨直肠窝穿刺点穿刺针血管神经束阴部管解剖学研究

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