经阴道植入网片全盆底重建术的疗效及性生活质量评价  

Evaluation of Surgery Efficiency and Impact of Sexual Life After Total Pelvic Floor Reconstruction with Vaginal Mesh

作　　者：魏冬梅[1] 王平[1] 牛晓宇[1] 

机构地区：[1]四川大学华西第二医院,四川成都610041

出　　处：《实用妇产科杂志》2015年第6期434-438,共5页Journal of Practical Obstetrics and Gynecology

摘　　要：目的：全面探讨经阴道植入网片全盆底重建术治疗盆腔器官脱垂（POP）的疗效、并发症及手术对性生活质量的影响。方法：回顾性分析我院2011年1月至2013年12月160例重度POP行经阴道植入网片全盆底重建术的临床资料并进行随访,观察手术时间、留置尿管时间、术中出血及住院时间等,以了解手术安全性。比较手术前后POP分度评价手术疗效。进行盆底功能影响问卷-7、-20（PFIQ-7、PFDI-20）和盆腔器官脱垂/尿失禁性生活质量问卷-12（PISQ-12）,评价手术前后生活质量及性生活质量的改善情况。结果：平均手术时间100.36±40.40分钟,住院时间4.50±1.30天,平均术中出血量150.35±80.30 ml,留置尿管时间3.50±1.50天。术中膀胱损伤4例（2.50%）,术后留置尿管1周后好转。随访8～44个月,中位随访时间26月,POP-Q分度及有性生活患者PISQ-12评分较术前明显改善,术后PFIQ-7和PFDI-20评分较术前显著降低,差异均有统计学意义（P〈0.05）。术后复发13例（8.13%）,阴道网片侵蚀5例（3.13%）,术后膀胱过度活动症8例（5.00%）。13例中,再次手术8例,有手术客观治愈91.88%（147/160）,患者主观满意率86.25%（138/160）。保留子宫组术后PISQ-12评分46.1±4.27分,子宫切除组术后PISQ-12评分28.3±5.26分,两组比较差异有统计学意义（P〈0.01）。结论：应用阴道网片的全盆底重建术是治疗重度POP的一种微创、有效的手术方式。全盆底重建术时保留子宫可能可以更好地改善性生活质量。Objective： To explore the clinical efficiency,safety,postoperative complications and the impact on sexual life after total pelvic floor reconstruction for severe pelvic organ prolapse（ POP Ⅲ- Ⅳ）. M ethods： The medical charts of 160 patients with POPⅢ- Ⅳ who underwent total pelvic floor reconstruction surgery in Gynecology Department of Sichuan University West China Second Hospital from January 2011 to December 2013 were reviewed,the detailed information including operation time,blood loss during and after surgery,fever,hospitality time,recovery of bladder function and intestinal function were all evaluated for surgery safety. The score changes of POP-Q before and after surgery were compared for surgery efficacy. The pelvic floor impact questionnaire-short form 7（ PFIQ-7）,pelvic floor distress inventory-short form 20（ PFDI-20） and pelvic organ prolapse-urinary incontinence and sexual questionnaire（ PISQ-12） were used to investigate the change of quality of life and sexuality. Results： The mean operation time was（ 100. 36 ± 40. 40） minutes,mean blood loss was（ 150. 35 ± 80. 30） ml,hospitality time was（ 4. 5 ± 1. 3） days,Foley-catheter was kept about 3. 5 ± 1. 5 days,intraoperatively there were 4 cases of bladder injury（ 2. 50%）,a week after the condition were improved by placing a urinary catheter. The patients were followed averagely 26 months（ 8-44 months）,POP-Q scores were significantly improved（ P〈0. 05）.The scores of PFIQ-7 and PFDI-20 after treatment were much lower than those before treatment（ P〈0. 05）. The scores of PISQ of patients with sexual life after treatment were much higher than those before treatment（ P〈0. 05）. Thirteen patients had recurred POP（ 8. 13%）,eight patients had re-operation. Five patients had mesh exposion in vagina（ 3. 13%） and eight patients were found de novo overactive bladder（ 5. 00%）. In this series,The objective cure rate was 91. 88% and the subjective cure rate was 86. 25%. The PISQ-12 score post

关 键 词：盆腔器官脱垂 阴道网片 全盆底重建术 生活质量 手术疗效 

分 类 号：R713[医药卫生—妇产科学]