全子宫切除术后穹隆疝的手术处理及临床分析  

The clinical analysis of surgery methods for vault hernia after total hysterectomy

作　　者：秦美英 夏志军[1] QIN Meiying XIA Zhijun(Department ofGynecology, Shengjing Hospital of China Medical University. Shenyang 110004, China)

机构地区：[1]沈阳中国医科大学附属盛京医院妇科盆底疾病病房辽宁省盆底诊治中心,110004

出　　处：《中国妇产科临床杂志》2017年第2期109-112,共4页Chinese Journal of Clinical Obstetrics and Gynecology

基　　金：中华预防医学会科研基金支持项目(20130606);科技部国家科技支撑计划课题(2014BAI05B02)

摘　　要：目的探讨因子宫脱垂或其他因素行全子宫切除术后发生穹隆疝的处理方式。方法对2011年1月至2015年12月就诊于中国医科大学附属盛京医院行全子宫切除术后发生盆腔器官脱垂107例及其中的80例穹隆疝患者的手术处理方式进行回顾性分析。结果 107例患者中,单纯膀胱膨出或直肠膨出27例;以穹隆膨出为主,伴或不伴有膀胱和直肠膨出80例。80例患者中,子宫脱垂行全子宫切除32例,其他原因行全子宫切除48例;重度压力性尿失禁14例,尿动力学提示隐匿性尿失禁3例;行经阴道置入网片的盆底重建术76例,其中全盆底重建术56例,中盆腔重建术20例;2例腹腔镜下阴道骶骨固定术,1例单纯疝囊修补术,1例前盆底重建术+疝囊修补术。17例压力性尿失禁患者中,16例术中同时行TVT-O术。随访至2016年12月,平均随访时间38个月,无复发病例,3例患者出现网片暴露,1例隐匿性尿失禁患者于术后1年因尿失禁症状较重,行TVT-O手术。结论置入网片的盆底重建术是治疗子宫切除术后阴道穹隆疝的一种有效的手术方式,术前根据穹隆疝及合并阴道前后壁脱垂的程度选择恰当的手术重建方式。对于术前合并压力性尿失禁或隐匿性尿失禁患者术中应同时行TVT-O手术。Objective To analyze the surgical treatment for vault hernia after total hysterectomy.Methods Data of 107 cases of pelvic organ prolapse after total hysterectomy treated in China Medical University Affiliated Shengjing Hospital from January 2011 to December 2015 was retrospectively analyzed.Results 27 of the 107 cases were suffered mainly simple anterior or posterior vaginal wall prolapse,while 80 cases had vault hernia,with or without the anterior or posterior vaginal wall prolapse.32 of the 80 cases were previously treated with total hysterectomy for uterine prolapse,while 48 cases for other reasons.Of the 80 cases,14 cases were complicated with severe stress urinary incontinence,while 3 cases had occult urinary incontinence.2 of the 80 cases were treated with laparoscopic sacrocolpopexy.One patient underwent simple repair of hernia sacandanother hadanterior pelvic floor reconstruction and hernia sac repair.56 cases received the total pelvic floor reconstruction,while 20 cases had middle pelvic reconstruction.16 in 17 cases with stress urinary incontinence were treated with TVT-O during the operation.All cases were followed up until December 2016.No recurrence happened.3 patients suffered from mesh exposure.One patient underwent TVT-O operation one year postoperatively because of severe urinary incontinence or occult incontinence.Conclusion Pelvic floor reconstruction with mesh is an effective treatment for vault hernia after hysterectomy.We should choose an appropriate reconstruction method according to preoperative prolapse degree of vault hernia and anterior or posterior vaginal wall.The patients combining with stress urinary incontinence or occult incontinence should be treated with anti-incontinence surgery at the same time.

关 键 词：子宫切除术后 穹隆疝 盆底重建术 

分 类 号：R713.42[医药卫生—妇产科学]