Prolift盆底重建术治疗重度盆腔器官脱垂的临床效果及预后影响因素分析  

Clinical Effects of Prolift Pelvic Floor Reconstruction on Severe Pelvic Organ Prolapse and Analysis of Influencing Factors of Prognosis

作　　者：周明书[1] 伊诺[1] 曹彦君[1] 卫雅娴 张震宇[2] 康楷 ZHOU Ming-shu;YI Nuo;CAO Yan-jun;WEI Ya-xian;ZHANG Zhen-yu(Department of Obstetrics and Gynecology,Beijing Ditan Hospital Affiliated to Capital Medical University,Beijing 100015,China;Department of Obstetrics and Gynecology,Beijing Chaoyang Hospital Affiliated to Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京地坛医院妇产科,北京100015 [2]首都医科大学附属北京朝阳医院妇产科,北京100020 [3]不详

出　　处：《临床误诊误治》2020年第3期97-101,共5页Clinical Misdiagnosis & Mistherapy

基　　金：首都卫生发展科研专项基金(2018-1-1061)。

摘　　要：目的观察Prolift盆底重建术治疗重度盆腔器官脱垂(pelvic organ prolapse,POP)的临床效果及预后影响因素。方法回顾性分析2015年1月—2018年5月行Prolift盆底重建术治疗的214例重度POP的临床资料,记录手术及随访情况,观察临床疗效,评价术前、术后1年标准盆腔器官脱垂定量(pelvic organ prolapse quanfitafion,POP-Q)分度、盆底功能障碍问卷-20(pelvic floor distress inventory-short form-20,PFDI-20)评分、盆腔器官脱垂/尿失禁性生活问卷-12(pelvic organ prolapse/urinary incontinence sexual questionnaire short form-12,PISQ-12)评分。根据临床疗效,将客观治愈者及主观治愈者作为预后良好组,将无效者及复发者作为预后不良组,采用多因素logistic回归分析探究影响重度POP患者预后的危险因素。结果214例手术时间为69~112(86.28±10.16)min;术中出血量71~124(98.46±15.42)ml;术后阴道壁长度≥5 cm 94例,<5 cm 120例。8例术后出现网片暴露侵蚀情况,经对症处理后症状消失。随访1年,预后良好组186例,预后不良组28例,总治愈率86.92%。214例重度POP术后1年POP-Q分度、PFDI-20评分较术前降低,PISQ-12评分较术前升高,差异有统计学意义(P<0.01)。多因素logistic回归分析显示,体质量指数≥24.00 kg/m 2、术前POP-Q分度Ⅳ度、脱垂部位为前盆腔、术后阴道壁长度≥5 cm是影响重度POP患者预后的独立危险因素(P<0.05或P<0.01)。结论Prolift盆底重建术治疗重度POP临床疗效显著,明显改善了患者生活质量,并且积极对体质量指数≥24.00 kg/m 2、术前POP-Q分度Ⅳ度、脱垂部位为前盆腔、术后阴道壁长度≥5 cm的重度POP患者进行干预可有效改善预后。Objective To observe the clinical effects of Prolift pelvic floor reconstruction in the treatment of severe pelvic organ prolapse(POP)and the influencing factors of prognosis.Methods The clinical data of 214 patients with severe POP who underwent Prolift pelvic floor reconstruction from January 2015 to May 2018 were retrospectively analyzed.The surgery and follow-up were recorded,and the clinical efficacy was observed.The pelvic organ prolapse quantification(POP-Q)indexing and scores of pelvic floor distress inventory-short form-20(PFDI-20)and pelvic organ prolapse/urinary incontinence sexual questionnaire shot form-12(PISQ-12)were evaluated before surgery and at 1 year after surgery.According to the clinical efficacy,objectively cured patients and subjectively cured patients were set as good prognosis group,and patients with ineffective treatment or recurrent disease were set as poor prognosis group.Multivariate logistic regression analysis was used to explore the risk factors influencing the prognosis of severe POP.Results The duration of surgery of 214 cases was 69-112(86.28±10.16)min,and the intraoperative blood loss was 71-124(98.46±15.42)ml.There were 94 cases with postoperative vaginal wall length≥5 cm and 120 cases with the length<5 cm.Eight cases experienced mesh exposure and erosion after surgery,and the symptoms disappeared after symptomatic treatment.At 1-year follow-up,186 patients had good prognosis,while 28 had poor prognosis,and the total cure rate was 86.92%.The POP-Q indexing and PFDI-20 score among 214 cases of severe POP at 1 year after surgery were significantly decreased while the PISQ-12 score was significantly increased,as compared with those before surgery(P<0.01).Multivariate logistic regression analysis showed body mass index(BMI)≥24.00 kg/m 2,stageⅣof preoperative POP-Q indexing,anterior pelvic cavity as prolapse site and postoperative vaginal wall length≥5 cm were independent risk factors for prognosis of severe POP(P<0.05 or P<0.01).Conclusion Prolift pelvic floor reconstru

关 键 词：盆腔器官脱垂 Prolift盆底修复系统 尿失禁 生活质量 预后 

分 类 号：R711.2[医药卫生—妇产科学]