阴道翻新术加用猪小肠黏膜下层补片的临床效果及安全性  

Clinical efficacy and safety of vaginal rejuvenation surgery with porcine small intestine submucosa

作　　者：梁向华[1] 张丽丽[1] 

机构地区：[1]北京积水潭医院妇科,100035

出　　处：《中华医学美学美容杂志》2015年第1期29-32,共4页Chinese Journal of Medical Aesthetics and Cosmetology

摘　　要：目的 探讨阴道翻新术（VRR）中首次加用猪小肠黏膜下层（SIS）补片的临床疗效.方法 对18例Ⅵ度阴道松弛者.阴道前壁横向折叠缩窄缝合膀胱外筋膜,7号丝线缝合盆筋膜腱弓、膀胱筋膜、SIS补片和阴道黏膜下组织,两侧各3针固定.阴道后壁横向折叠缩窄缝合直肠阴道隔,7号丝线缝合盆筋膜腱弓、直肠筋膜、SIS补片和阴道黏膜下组织,两侧各3针固定.丝线缝合断裂的肛提肌、肛门括约肌浅肌群、会阴浅横肌和球海绵体肌.失败为阴道横径大于3.5 cm.结果 术后随访中位数13个月.18例外阴道横径、生殖道裂孔（gh）长度和会阴体（pb）长度改变差异有统计学意义（P＜0.01）.13例盆底器官脱垂/尿失禁性功能问卷（PISQ-12）评分提高差异有统计学意义（P＜0.01）,18例盆底功能障碍问卷（PFDI-20）和盆底功能影响问卷（PFIQ-7）评分下降差异有统计学意义（P＜0.01）.1例阴道直径4.0 cm,手术失败.5例因其他原因没有性生活.没有感染、侵蚀和排斥.没有压力性尿失禁.结论 解剖学修复损伤的盆底组织是VRR最有效的手术方法.加用SIS补片可以增加阴道强度,减少瘢痕形成,特别是减少复发.Objective To evaluate efficacy and safety of porcine small intestine submucosa （SIS） for the repair of severe vaginal relaxation （stage Ⅳ） in women.Methods Biological repair meshes were fixed in 18 patients with stage Ⅵ vaginal relaxation,among which anterior walls were fixed in 12 cases,posterior walls in 5 cases,and both walls in 1 patient.Patients with POP underwent vaginal vault suspension first,then patient with SUI underwent transvaginal urinary incontinence surgery.Extravesicle fascia was transversely folded and sutured with 2-0 Mousse.The pelvic arch ligament together with vesicle fascia,SIS mesh and vaginal submucosa were sutured 3 stitches per side with 1-0 Mousse.Scar tissue at posterior vaginal wall was rhombically excised followed by transverse folding constriction of the rectovaginal fascia with 2-0 Mousse.A 1-0 Mousse was then used for colpoperineoplasty by suturing ruptured superficial anal sphincter,superficial transverse perineal muscle,and bulbocavernosus muscle.Patients were followed at 2,6,and 12 months post-operatively.Unsuccessful outcome was defined as diameter of outer 1/3 of vagina greater than 3.5 cm,or vagina prolapsed beyond hymen.Results The median follow-up was 13 months.Pelvic Organ Prolapse/Urinary Incontinence/Sexual Function Short Form Questionnaire （PISQ-12） was obtained in 13 patients and the score increased was noted （P＜0.01）.Pelvic floor distress inventory-short form for scoring the quality of life （PFIQ） was collected from 18 patients and the score decreased was noted （P＜0.01）.Pelvic floor impact questionnaire （PFIQ-7） was gathered in 18 patients and the score decreased was noted （P＜ 0.01）.One unsuccessful case with stage Ⅱ anterior vaginal wall prolapse who underwent posterior vaginal wall fixed with patch ended with a diameter of outer 1/3 of vagina greater than 4.0 cm post-operation.Severe complications like infection,rosion,rejection or SUI were not noticed in any case.Conclusions The anatomical repair of pelvic floor is the m

关 键 词：阴道松弛 阴道翻新术 猪小肠黏膜下层 

分 类 号：R713.3[医药卫生—妇产科学]