前盆底重建术联合骶棘韧带固定术与全盆底重建术治疗重度盆底器官脱垂的疗效分析  

The analysis of the effects of the anterior vaginal wall mesh combined with sacrospinous ligament and the total pelvic floor reconstruction in the treatment of pelvic organ prolapse

作　　者：舒慧敏 杨宾烈[2] 陈华[3] 丁慧 杜贵强 戴志远 Shu Huimin;Yang Binlie;Chen Hua(Department of Gynecology,Shanghai First Maternity and Infant Hospital,Tongji University School of Medicine,Shanghai 201204;People's Hospital,Shanghai Pudong New Area,Shanghai 201200;Gongli Hospital,Shanghai Pudong New Area,Shanghai 200135)

机构地区：[1]同济大学附属第一妇婴保健院妇科,上海201204 [2]上海市浦东新区人民医院,上海201200 [3]上海市浦东新区公利医院,上海200135

出　　处：《现代妇产科进展》2018年第9期665-668,共4页Progress in Obstetrics and Gynecology

基　　金：上海市浦东新区联合攻关项目(No:PW2015D-9)

摘　　要：目的:研究前盆底重建术联合骶棘韧带固定术与全盆底重建术治疗重度盆底器官脱垂(POP)的疗效,探讨临床应用价值。方法:回顾分析2012年7月至2015年3月因重度POP行前盆底重建术联合骶棘韧带固定术的患者45例和行全盆底重建术的患者33例。分析手术时间、术中出血量、术后病率、手术前后POP-Q各指示点位置及生活质量变化。结果:前盆底重建术联合骶棘韧带固定术组和全盆底重建术组的平均手术时间分别为(94.7±19.5)min和(114.0±11.8)min,平均术中出血量(73.1±37.6)ml和(148.0±56.0)ml,术后病率分别为4.4%和9.1%。随访3年,POP-Q指示点与术前比较,差异有统计学意义;术前与术后3年PFDI-20、PISQ-12评分比较,两组差异有统计学意义(P<0.05)。术后两组各有1例复发,均为中盆腔脱垂;前盆底重建术联合骶棘韧带固定术组有2例网片暴露,全盆底重建术组有1例网片暴露,均在阴道前壁。结论:与全盆底重建术相比,前盆底重建术联合骶棘韧带固定术手术时间短、出血少、损伤小,短期及中期疗效确切。Objective:To study the effects of two different repair techniques-combined anterior vaginal wall mesh with sacrospinous ligament fixation(SSLF)and the total pelvic floor reconstruction in the treatment of pelvic organ prolapse(POP).Method:This was a retrospective study including information from 45 symptomatic women with pelvic floor prolapse.The patients underwent transvaginal modified anterior vaginal wall mesh combined with sacrospinous ligament fixation(SSLF)between Jul.2012 and Mar.2015.33 cases with pelvic floor prolapse underwent total pelvic floor reconstruction in the sametime.The perioperative parameters including surgical tim e,blood loss,and intraoperative complications were recorded.The pelvic organ prolapse quantitation(POP-Q)system was measured before and after operation to evaluate the anatomical cure rate and recurrence rate.The pelvic floor distress inventory short form(PFDI-20)and pelvic organ prolapse-urinary incontinence sexual questionanaire-12(PISQ-12)to evaluate the subjective prolapse function recovery as well as the sexual function.R e su lts:The mean surgical time of the two groups was(94.7±19.5)min and(114.0±11.8)min respectively.The mean estimated blood loss was(73.1±37.6)ml.The rate of postoperative fever was 4.4%and 9.1%.All cases had a minimal 3 years follow-up.Postoperative each indicator point of POP-Q presented significant improvement compared to the preoperative.Postoperative PFDI 20 was significant improvement compared to the preoperative in two groups.PISQ-12 score presented significant improvement in the combined anterior vaginal wall mesh with sacrospinous ligament fixation group after operation and decline in the total pelvic floor reconstruction group.There was one case recurrence in each group.In the combined anterior vaginal wall mesh with sacrospinous ligament fixation group,2 cases were exposed,and 1 in the total pelvic floor reconstruction group was exposed to the anterior wall of the vagina.Conclusion:Compared with the total pelvic floor reconstruction,anterior v

关 键 词：前盆底重建术 骶棘韧带固定术 全盆底重建术 盆底器官脱垂 

分 类 号：R711.2[医药卫生—妇产科学]