子宮脱の病型分類と治療法の個別化

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A urethrocystohysterography (UCHG) and a prolapse scoring system (PSS) have been used to assess the types of uterine prolapse and postoperative outcomes since 1979. UCHG was useful in identifying the type of uterine prolapse and in selecting operative procedure. UCHG was done by injecting contrast medium into the bladder and uterine cavity and inserting a metallic bead chain into the urethra. A lateral pelvic X-ray was then taken at rest and during straining. The length of the uterus (UL), distance from the pelvic outlet (PO) to the bladder base (BB), distance from PO to the uterine fundus (UF), and distance from the ischial spine (IS) to UF were measured on the UCHG. We found that there were three types of uterine prolapse on the UCHG findings, type 1 : cervical elongation without descent of uterine fundus and cystocele, type 2 : uterine prolapse with moderate descent of uterine fundus and cystocele, and type 3 : giant vaginal eversion including completely prolapsed uterus, marked cystocele, enterocele and rectocele. The operative time of vaginal hysterectomy with anterior and posterior colporthaphy (VH with AP repair) correlated well with UL and PO-UF distance on UCHG, and blood loss. Operating time was significantly shorter and amount of blood loss was significantly smaller in cases of Machester operation (cervical amputation, fixation of cardinal ligament stumps to the anterior wall of the remaining cervix and AP repair) than in those of VH with AP repair. Therefore, Machester operation has been applied to the cases of the type 1 prolapse (PO-FU distance > FO-IS distance on UCHG) (group 1), and VH with AP repair to those of the type 2 prolapse (PO-UF distance < PO-IS distance) (group 2). Sacrospinous ligament fixation to the vaginal apex was combined to VH with AP repair in cases of type 3 prolapse (group 3), althogh these cases were rare. A scoring system was used to evaluate the effects of operation. Urethrocele U), cystocele (C), uterine prolapse (P), enterocele (E) and rectocele (R) were scored from 0 (no prolapse) to 4 (complete prolapse), respectively, and the scores were recorded as 2,3-4-2,1 (U,C-P-E,R). The score of P means that of vaginal apex in case of posthysterectomy. There was no significant difference in the mean postoperative scores of any part of the vagina among the groups. These results warrant the aforementined individualizatin of the operative procedures.
社団法人日本産科婦人科学会の論文
1992-08-01

子宮脱の病型分類と治療法の個別化

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