探讨老龄女性改良阴道全封闭伴子宫切除术治疗重度全盆底缺陷盆腔器官脱垂（POP）的安全性和有效性。

选择2017年1月至2020年6月于首都医科大学附属北京朝阳医院行改良阴道全封闭伴子宫切除术治疗的重度全盆底缺陷POP老龄女性24例，经阴道或腹腔镜辅助阴道手术切除子宫后继续切除阴道黏膜，将阴道重建成总长度为3.0～3.5 cm、下段直径2.0～2.5 cm、顶端纵膈1.0～1.5 cm残留盲端阴道，压力性尿失禁同时行经阴道前壁闭孔突途径尿道中段悬吊术手术。

24例患者均存在包括前中后三腔室在内的全盆底重度缺陷，POP-Q分期Ⅲ°～Ⅳ°。年龄（76.5±6.2）岁。全部患有原发性高血压病（100%）、糖尿病（20.8%）、冠状动脉粥样硬化伴狭窄或心肌梗死（41.6%）、脑梗脑血栓伴肢体运动障碍后遗症（16.7%）、骨关节退行性变（16.7%）等两种以上合并症，58.3%合并女性压力性尿失禁。手术时间（201.4±44.7）min，术中出血量（206.7±135.6）ml，术后并发症有下肢肌间静脉血栓4例（16.7%）、肺血栓1例（4.2%）、尿潴留7例（29.2%），均治愈。术后住院时间（8.9±3.0）d。完成6～24个月随访19例，保留阴道达到客观设计要求，主观满意度和客观有效率均为100%。

改良阴道全封闭伴子宫切除术用于老龄女性重度全盆底缺陷POP，经多学科协作围手术期监护能够有效保证手术安全性，获得较高外观美学和主观满意度。

To investigate the safety and efficacy of the modified total colpocleisis concomitant with hysterectomy in treatment of elderly women with severe pelvic organ prolapse (POP) with total pelvic floor defect.

From January 2017 to June 2020, a total of 24 elderly patients with total pelvic floor defect and POP were admitted to gynecologic department of Beijing Chaoyang Hospital, Capital Medical University, who no longer desired coital function. All patients underwent modified total colpocleisis and hysterectomy. The vagina was reconstructed into a vaginal remnant with a total length of 3 to 3.5 cm, a lower diameter of 2 to 2.5 cm, and a top mediastinum of 1 to 1.5 cm. TVT-O was performed simultaneously for stress urinary incontinence.

All 24 patients had severe defects of anterior, middle and posterior compartments of the pelvic floor, POP-Q stage Ⅲ-Ⅳ of POP, and age (76.5±6.2) years old. All patients had more than two kinds of complications, including hypertension (100%), diabetes (20.8%), coronary atherosclerosis with stenosis or myocardial infarction (41.6%), cerebral infarction with sequelae of limb dyskinesia (16.7%), bone and joint degeneration (16.7%), and 58.3% of cases had female stress urinary incontinence. The mean operative time was (201.4±44.7) minutes, estimated blood loss was (206.7±135.6) ml. Postoperative complications included lower limb intermuscular venous thrombosis (16.7%), pulmonary thrombosis (4.2%), and urinary retention (29.2%), and all were cured. 19 patients were followed up for 6 to 24 months postoperatively, and the vaginal remnant met the objective designed requirements. There was no recurrence. The overall efficacy was 100%. The subjective satisfaction was 100%.

This modified total colpocleisis concomitant hysterectomy for elderly women with severe total pelvic floor and POP is efficacy and safety. The vaginal remnant can obtain higher aesthetic appearance and the subjective satisfaction.