盆底重建术后盆底肌肉功能评估的前瞻性研究  

A prospective study of the evaluation of pelvic floor muscle function after pelvic floor reconstruction

作　　者：任贺亚 孙智晶[1] 朱兰[1] 郎景和[1] 徐涛[2] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院妇产科,北京100730 [2]中国医学科学院基础研究所北京协和医学院基础学院,北京100730

出　　处：《中国实用妇科与产科杂志》2017年第8期845-849,共5页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：十二五国家科技支撑项目(2014BAI05B02);国家自然科学基金面上项目(81671442)

摘　　要：目的探讨自身组织修复和网片置入两种盆底重建术后盆底肌肉的功能及术后生活质量。方法选取2013年9月至2016年9月于北京协和医院行盆底重建手术,并于2014年9月至2016年12月门诊随访患者共130例。以是否放置网片将患者分为网片组及自身组织修复组,以随访时间不同分为术后3个月随访组及术后1年随访组,在术后3个月及术后1年对其进行盆底肌肉功能评估和生活质量、性生活质量的评估。结果不同术式组、不同随访时间组术后盆底肌力差异无统计学意义(P>0.05)。不同术式患者阴道动态压力及生活质量评分差异均有统计学意义(P=0.005,P=0.037),网片组优于自身组织修复组。不同术式阴道动态压力与POP-Q分度各指示点仅网片组与Aa点(P=0.029)、Ba点(P=0.031)相关,盆底Ⅱ类肌肌力与Bp点(P=0.041)相关,网片组术后3个月随访患者盆底Ⅰ类肌力与Aa点(P=0.026)、Ba点(P=0.038)、C点(P=0.038)相关,盆底Ⅱ类肌力与Aa点(P=0.049)、Ba点(P=0.025)、C点(P=0.011)、Ap点(P=0.032)、Bp点(P=0.05)相关;术后1年随访患者盆底Ⅰ类肌力与Aa点(P=0.015)、Ba(P=0.037)相关。结论网片置入盆底重建手术不影响患者盆底肌肉功能,盆底重建术可改善盆底功能。经盆底肌肉功能锻炼是否可加强盆底重建术后患者盆底肌肉功能需进一步研究。Objective To study the pelvic floor muscle function and the life quality after two kinds of pelvic floor reconstruction：the mesh and the native tissue repair.Methods Totally 130 patients,who underwent pelvic reconstructive surgery in Peking Union Medical College Hospital from September 2013 to September 2016 and were followed up from September 2014 to December 2016,were selected in the study.They were divided into mesh group and native tissue repair group according to whether there was mesh implantation or not,and were also divided into 3-month group and 1-year group by the different follow-up time.The pelvic floor muscle function,the life quality and the sexual life quality were evaluated at 3 months and 1 year after the operation.Results There was no significant difference in the pelvic floor muscle strength between the mesh and the native tissue repair group,as well as between the different follow-up groups（P〈0.05）.There were significant differences in vaginal dynamic pressure and PFIQ-7 score between mesh and native tissue repair group（P=0.005,P=0.037）.The mesh group was better than the native tissue repair group.In mesh,only Aa（P=0.029）and Ba（P=0.031）of POP-Q were related to vaginal dynamic pressure in different operative methods.The type Ⅱ pelvic floor muscle strength was associated with Bp（P=0.041）.After 3 months of the operation in mesh group,the type Ⅰ pelvic floor muscle strength was related to Aa（P=0.026）,Ba（P=0.038）,C（P=0.038）,the typeⅡpelvic floor muscle strength was relevant to Aa（P=0.049）,Ba（P=0.025）,C（P=0.011）,Ap（P=0.032）,Bp（P=0.005）at 3 months after operation.The typeⅠpelvic floor muscle strength was associated with Aa（P=0.015）、Ba（P=0.037）in 1-year followup.Conclusion Mesh dose not affect the pelvic floor muscle strength.Pelvic floor reconstruction can improve pelvic floor function.Whether pelvic floor muscle training（PFMT）will improve the function of pelvic floor muscles after pelvic reconstruction surgeries needs furt

关 键 词：盆底功能障碍性疾病 生物相容性材料 生活质量 盆底肌肉功能 

分 类 号：R713.43[医药卫生—妇产科学]