Prolift盆底重建术后复发的处理  

Strategy on recurrent pelvic organ prolapse after Prolift system surgery

作　　者：刘小春[1] 朱兰[1] 郎景和[1] 史宏晖[1] 龚晓明[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,北京100730

出　　处：《现代妇产科进展》2012年第2期81-84,共4页Progress in Obstetrics and Gynecology

基　　金："十一五"国家科技支撑计划基金项目(No:2007BAI04B05)

摘　　要：目的:探讨Prolift盆底重建术后复发的处理方法。方法:回顾分析我科目前收治的Prolift盆底重建术后复发患者的临床资料,以盆腔器官脱垂定量分期法为指标评价解剖学疗效,用生活质量问卷及性生活问卷为指标评价功能学疗效。结果:复发病例中1例未保留子宫的Prolift盆底重建者术后2年复发,目前放置子宫托疗效满意。4例保留子宫的Prolift盆底重建术后患者短期内(2～6月)复发,且均发生宫颈延长,经子宫切除术结合阴道顶端坐骨棘筋膜固定术后,3例解剖恢复良好,问卷评分示生活质量显著提高,1例因再次复发而行阴道封闭术。2例存在明显的网片侵蚀及症状性皱缩,分次剪除配合局部雌激素后治愈。结论:Prolift盆底重建术后复发病例的进一步处理目前处于初步探索阶段。子宫托保守治疗可作为首选。手术治疗建议切除存在宫颈延长的子宫结合阴道顶端固定术。坐骨棘筋膜固定术是操作简便、费用低廉的顶端固定术式,初步临床结局尚可,远期疗效有待进一步观察。经上述处理再复发者建议行阴道封闭术。Objective：To investigate the clinical strategy for recurrent pelvic organ pro- lapse after Prolift system surgery. Methods： Review retrospectively the clinical records of all cases of recurrent pelvic organ prolapse after Prolift system surgery. 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. Results： 1 case who was subjected to Prolift system surgery with concomitant hysterectomy recurred pelvic organ prolapse after 2 years, patient was satisfactory with treatment of pessary so far. 4 cases who were subjected to uterus-sparing Prolift system surgery recurred pelvic organ prolapse in short term （2 -6 months）, and all were concurrent with prolonged cervix. After hysterectomy combined with ischial spinous fascia fixation,3 cases got satisfactory anatomic effect with significant improvement on postoperative Quality of Life Scores, however, 1 case recurred pelvic organ prolapse after 7 months and accepted colpocleisis finally. In addition,2 cases showed severe mesh erosion and symptomatic shrinkage, and partial mesh removal combined with local estrogen was demonstrated a good choice. Conclusions：Strategy on recurrent pelvic organ prolapse after Prolift system surgery is at initial exploration phase. Pessary can be selected firstly. Suggestion on operative treatment is removal of uterus with prolonged cervix combined with vaginal apical fixation. Ischial spinous fascia fixation is a low-cost, safe, and simple operation of vaginal apical fixation. Its primary clinical outcome is efficacious, however, long-term effect should be observed further. Colpocleisis is recommendation to recurrence again.

关 键 词：盆底重建术 盆腔器官脱垂 复发性 临床处理 

分 类 号：R711.2[医药卫生—妇产科学]