改良前盆底重建术对膀胱Ⅲ、Ⅳ度脱垂患者膀胱解剖结构及功能恢复的研究  

Research on bladder anatomical and functional recovery after modified anterior pelvic floor reconstruction

作　　者：陈艳琴[1] 龚健[1] 王家俊[1] 邹少晗[1] 黄益娟[1] 

机构地区：[1]南京医科大学附属无锡妇幼保健院泌尿妇科,江苏无锡214002

出　　处：《现代医学》2010年第3期246-249,共4页Modern Medical Journal

摘　　要：目的:改良前盆底重建术治疗膀胱Ⅲ、Ⅳ度脱垂,探讨其对膀胱解剖结构及功能恢复的效果。方法:对119例Ⅲ、Ⅳ度膀胱脱垂患者行改良经闭孔无张力聚丙烯补片前盆底重建术,伴有压力性尿失禁(SUI)和混合性尿失禁(MUI)的患者同时行经闭孔尿道中段无张力阴道悬吊术(TVT-O)。通过比较手术前后POP-Q(the pelvic organ prolapse quantitative examination)分度和盆底功能障碍问卷(POPDI-6、UDI-6)来判断其膀胱的解剖结构及功能恢复情况,同时分析术后并发症及性激素治疗(HT)对下尿路症状和阴道伤口愈合的影响。结果:(1)随访半年119例、1年66例、2年32例,其解剖结构的恢复客观治愈率分别为100%、95.06%及93.75%。(2)单次排尿量增多;漏尿、尿频、尿急症状得到改善,改善率分别为91.4%、92%、100%。(3)术后接受HT及未接受HT尿路症状改善率分别为100%、78.9%。结论:(1)改良前盆底重建术有助于膀胱解剖结构及功能的恢复。(2)术后接受HT,可改善患者下尿路症状,促进阴道伤口愈合。Objective：To evaluate bladder anatomical and functional recovery after modified anterior pelvic floor reconstructive surgery for bladder prolapse Ⅲ-Ⅳ degrees.Methods：Modified anterior pelvic floor reconstruction were performed in 119 patients with bladder prolapse Ⅲ-Ⅳ degrees.Patients with SUI（stress urinary incontinence）or MUI（mixed urinary incontinence）were simultanously treated with TVT-O.According to POP-Q（pelvic organ prolapse quantitation）,POPDI-6（pelvic organ prolapse distress inventory 6）and UDI-6（urinary distress inventory 6）,we evaluated bladder anatomical and functional recovery before and after surgery,and analyzed surgical complications.Lower urinary tract symptoms and vaginal wound healing were compared in patients treated with and without hormone therapy（HT）after surgery.Results：After the follow-up of 0.5,1 and 2 years,the objective cure rates in restoration of anatomic structure were respectively 100%,95.06% and 93.75%.Single voided volume increased（P〈0.05）.Leakage of urine,frequent urination,urgency symptoms were improved,with improvement rates of 91.4%,92% and 100%.Urinary symptom improvement rates in patients receiving and not receiving HT were 100% and 78.9%.Conclusion：Modified anterior pelvic floor reconstruction can help to improve anatomical and functional recovery of bladder.After surgery,HT can improve lower urinary tract symptoms and vaginal wound healing.

关 键 词：盆腔脏器脱垂 改良前盆底重建术 膀胱解剖结构 膀胱功能 

分 类 号：R694[医药卫生—泌尿科学]