经阴道应用化学合成网片行盆底重建术后复发18例临床分析  

Analysis of 18 recurrent cases after transvaginal pelvic floor reconstruction with synthetic mesh

作　　者：胡清[1] 夏志军[1] 刘丹[2] 林特[2] HU Qing XIA Zhoun LIU Dan LIN Te(Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang 110004, China)

机构地区：[1]中国医科大学附属盛京医院妇产科,沈阳110004 [2]中国医科大学研究生院

出　　处：《中国妇产科临床杂志》2017年第2期113-116,共4页Chinese Journal of Clinical Obstetrics and Gynecology

基　　金：科技部国家科技支撑计划(2014BAI05B02);国家科技部十二五“重大新药创制”科技重大专项(2012ZX09401004)

摘　　要：目的探讨经阴道应用合成网片行盆底重建术后复发的原因。方法选取2010年1月至2016年1月18例经阴道应用合成网片行全盆底重建术复发患者,综合评估患者的症状、体征、脱垂程度及再次手术治疗的效果。结果 18例复发患者中,重度子宫脱垂合并轻度阴道前后壁脱垂者5例;重度阴道前后壁脱垂伴其他部位轻度脱垂者4例,阴道穹隆脱垂合并重度阴道前后壁脱垂9例;伴严重排尿困难、排尿不尽2例;伴排便困难2例,均需还纳脱出物排便或排尿;伴压力性尿失禁2例。18例患者均行手术治疗,术中发现子宫颈环结构、位置异常5例,阴道前或后穹隆疝形成3例,既往全盆底重建术中合成网片穿刺部位不准确2例,网片挛缩、移位4例,给予子宫切除、阴道壁修补、疝囊结扎及再次植入网片的盆底重建等手术。平均随访(2.20±1.73)年(1~5年)。依据POP-Q分期法,术后无再次脱垂复发病例,解剖学恢复率100%,主观满意度100%。术后3个月,1例新发膀胱过度活动症,经生物反馈电刺激治疗后好转;1例阴道内线头暴露,剪除线头后恢复良好。结论全盆底重建术后复发原因可能与术中解剖层次不清,网片穿刺部位不准确,固定不牢,术后挛缩、折叠、移位,宫颈环结构处理不到位,以及术后长期腹压增高等有关。Objective To investigate the causes of recurrence after transvaginal pelvic floor reconstruction with application of synthetic mesh.Methods 18 patients with reccurent prolapse who were treated with transvaginal pelvic floor reconstruction with application of synthetic mesh in Shengjing Hospital from January 2010 to January 2016.The recruited in this study symptoms,signs,the degrees of prolapse and efficacy of reoperation were analyzed.Results 5 cases suffered from severe uterine prolapse with mild anterior and posterior vaginal wall prolapse while 4 cases had severe anterior or posterior vaginal wall prolapse with mild prolapse in other parts.9 cases suffered from vaginal vault prolapse with severe anterior or posterior vaginal wall prolapse.In these cases,2 had severe dysuria or dripping.2 cases had the symptoms of defecation difficulty and they tried tourinate or defecate by reducing the protrusion.Additionally 2 cases suffered from stress urinary incontinence（SUI）.All the 18 recurrent patients underwent reoperation.During the second operation,we found 5 cases of improper structures of pericervical ring,3 cases of herniation of anterior or posterior fornix of vagina,2 cases of inaccurate sites of puncture in previous surgery and 4 cases of mesh contracture and displacement.We treated them with hysterectomy,anterior colporrhaphy,ligation of hernial sac or reimplantation of mesh and the follow up time were 1 to 5 years（2.20±1.73）.According to the Pelvic Organ Prolapse Quantification system（POP-Q）,no recurrent cases were observed after reoperation.The successful rate of anatomic and subjective satisfaction were both 100%.3 months postoperatively one patient was diagnosed with overactive bladder（OAB） and her symptom was relieved by bio-feedback electric stimulation therapy.One patient suffered from the polypropylene threads exposionin vagina and we cut threads.Conclusion The main causes of recurrence after pelvic floor reconstruction are the lack of surgical anatomical separation,less clear layers

关 键 词：盆腔器官脱垂 网片 复发 盆底重建术 

分 类 号：R713[医药卫生—妇产科学]