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作 者:刘小春[1] 朱兰[1] 郎景和[1] 史宏晖[1] 龚晓明[1] 王文艳[2] 李琳[1] 李玢[1]
机构地区:[1]中国医学科学院北京协和医学院北京协和医院妇产科,100730 [2]安徽省蚌埠医学院第一附属医院肿瘤妇科
出 处:《中华医学杂志》2010年第41期2907-2910,共4页National Medical Journal of China
基 金:国家“十一五”科技支撑计划(2007BA104B05)
摘 要:目的 评价ProlifiTM全盆底重建术治疗复发性重度盆腔器官脱垂的临床疗效.方法 回顾分析13例复发性重度盆腔器官脱垂(穹隆脱垂合并阴道前后壁脱垂)行全盆底重建术的临床资料,盆腔器官脱垂定量分期法(POP-Q)为指标评价解剖学疗效,生活质量问卷为指标评价功能学疗效,性生活问卷为指标评价性生活情况.年龄平均(60±9)岁,均为绝经后患者,体质量指数平均(25.6±2.9)kg/m2.结果 手术均顺利完成,无膀胱、尿道、直肠、大血管损伤.无输血病例.手术时间(61±18)min,出血(155±84)ml,术后病率7.7%(1/13).中位随访19个月.1例术后尿潴留1周,其余均1~2 d自主排尿.1例(7.7%)网片侵蚀.新发性交痛、性交困难及膀胱过度活动症各1例.术后问卷评分显示生活质量显著提高(P<0.01),而性生活质量降低(P<0.05).解剖学成功率92.3%,患者主观满意度84.6%.结论 ProliftTM全盆底重建用于纠正复发性重度盆腔器宫脱垂手术安全、客观疗效满意,但主观满意度低于客观解剖成功率,对性功能的不良影响亦不容忽视.Objective To evaluate the clinical outcomes of total ProlifiTM system surgery for the repair of recurrent severe pelvic organ prolapse. Methods The clinical records of 13 cases of recurrent severe pelvic organ prolapse were retrospectively analyzed. The characteristic was vaginal vault prolapse in combination with anterior and posterior wall prolapse. Anatomic effect(according to POP-Q score),functional effect(according to prolapse quality of life)and sexual life(according to sexual life score)of each patient were assessed. All subjects were post-menopausal with a mean age(60 ±9)years and a mean BMI of(25. 6 ±2.9)kg/m2. Results All operations were accomplished successfully without any impairment of bladder, urethra, rectum, great vessels or nerves or blood transfusion. The mean operation time was (61 ± 18)minutes and the mean blood loss(155 ±84)ml. All patients were followed up for a medium of 19(15-30)months. Except for one post-operative urinary retention for a period of 7 days, 12 patients were able to micturate spontaneously 1 -2 d post-operatively with a residual urine volume of less than 100 ml.During follow-up, mesh erosion(n = 1), de novo overactive bladder(n = 1), one algopareunia(n = 1)and dyspareunia(n = 1)occurred. Postoperative Quality of Life Scores improved significantly(P 〈 0. 01).However, sexual life scores was impaired(P 〈 0. 05). The anatomic cure rate was 92. 3% and the patient subjective satisfactory rate 84. 6%. Conclusion The total ProliftTM system surgery represents a safe, simple and useful treatment for recurrent severe pelvic organ prolapse with satisfactory objective clinical outcomes.However, the level of patient subjective satisfaction is lower than objective cure rate. Meanwhile, harmful effects on sexual life remain a main concern.
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