改良Prolifl盆底重建术在治疗合并子宫颈延长的重度盆腔器官脱垂患者中的应用  

Modified Prolift procedure without trachelectomy or hysterectomy for the treatment of advanced pelvic organ prolapse complicated with cervical elongation

作　　者：李宝恒[1] 黄惠娟[1] 宋岩峰[1] 

机构地区：[1]南京军区福州总医院妇产科,350025

出　　处：《中华妇产科杂志》2016年第3期174-179,共6页Chinese Journal of Obstetrics and Gynecology

基　　金：福建省科技厅科技合作计划（201310006）

摘　　要：目的探讨改良Prolift盆底重建术在治疗合并子宫颈延长的重度盆腔器官脱垂中的疗效及安全性。方法选择2008年12月至2012年6月因重度盆腔器官脱垂合并子宫颈延长在南京军区福州总医院接受改良Prolift盆底重建术且资料完整的患者共72例，回顾性分析其临床资料，以盆腔器官脱垂定量分度法（POP-Q）评价术后脱垂治疗效果，并分析术后1年、2年、3年POP．Q各指示点的变化；观察手术并发症情况，采用盆底不适调查表简表（PFDI-20）评价患者术后的症状改善情况及主观满意率。结果72例患者，随访时间36～78个月，中位随访时间52个月。手术时间（125±31）min，出血量（146±73）ml。术中膀胱、直肠损伤各1例，及时处理，随访无异常主诉及并发症发生。改良Prolift盆底重建术客观成功率94％（68／72）；4例（6％，4／72）患者术后9～19个月重新出现Ⅲ～Ⅳ度子宫脱垂，予以切除子宫，随访未见脱垂复发。6例（8％，6／72）患者术后3—9个月出现网片暴露，除1例因暴露面积较大（约2em。）手术修剪外，其余均以雌三醇乳剂治愈，其后的随访中未发现新的网片暴露，也未发现脱垂复发。术后患者的不适症状消失或明显减轻，术前、术后PFDI-20评分[分别为术前（118．2＋25．2）分、术后1年（12．1＋8．0）分、术后2年（12．5＋9．5）分、术后3年（13．0±9．9）分]比较，差异有统计学意义（P〈0．05）；术后主观满意率92％（66／72）。结论改良Prolift盆底重建术治疗合并子宫颈延长的重度盆腔器官脱乖中期效果良好，复发率低．安全性高。Objective To evaluate the effect and safety of a modified Prolift procedure, without preceding partial trachelectomy or hysterectomy for pelvic organ prolapse （POP） with coexistent cervical elongation. Methods Clinical data of 72 patients that underwent a modified Prolift procedure for POP with coexistent cervical elongation, between December 2008 and June 2012 in Fuzhou General Hospital of Nanjing Military Command was retrospectively analysed. A comparison was carried out between preoperative and postoperative parameters of pelvic organ prolapse quantitation system （POP-Q）, and an objective evaluation was made according to the overall cure rate and recurrence rate. Pelvic floor distress inventory-short form 20 （PFDI-20） was used to investigate the subjective cure rate and improvement of symptoms. Results Patients were followed up at median 52 months （36-78 months）. One bladder perforation and one rectum perforation occurred during the procedure. Four patients （6%, 4/72） had uterine prolapse at 9-19 months after the opertaion and had transvaginal hysterectomy laterly. The overall anatomical correction rate was 94% （68/72）. Six patients （8%, 6/72） had mesh exposures at 3-9 months after the opertaion. Scores of PFDI-20 decreased sifnificantly after the procedure （118.2±25.2 vs 12.1±8.0 vs 12.5±9.5 vs 13.0±9.9, P〈 0.05）. The patients＇ satisfaction rate was 92% （66/72）. Conclusion This modified Prolift procedure, without preceding partial traeheleetomy or hysterectomy, could effectively and safely correct POP with coexistent cervical elongation.

关 键 词：盆腔器官脱垂 骨盆底 妇科外科手术 修复外科手术 外科网 子宫切除 术 子宫颈延长 

分 类 号：R713[医药卫生—妇产科学]