阴腹联合腹腔镜阴道骶骨固定术170例术后并发症分析  

Analysis of postoperative complications of 170 cases of vagina-assisted laparoscopic sacrocolpopexy

作　　者：陈礼全[1] 梁雪早 王苏[1] 林晓婷 徐丽珍[1] 张晓薇[1] CHEN Liquan;LIANG Xue-zao;WAN Su;LIN Xiao-ting;XU Li-zhen;ZHANG Xiao-wei(Department of Obstetrics and Gynecology,the First Affiliated Hospital of Guangzhou Medical College,Guangzhou 510120,China)

机构地区：[1]广州医科大学附属第一医院妇产科,广东广州510120

出　　处：《中国实用妇科与产科杂志》2020年第7期646-650,共5页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：广东省医学科学技术研究基金(B2020078)。

摘　　要：目的分析阴腹联合腹腔镜阴道骶骨固定术治疗Ⅲ~Ⅳ期盆腔器官脱垂的并发症情况,为经阴道植入网片手术提供中国临床真实数据。方法回顾性分析2009年5月至2018年1月期间因Ⅲ~Ⅳ期盆腔器官脱垂在广州医科大学附属第一医院妇科接受阴腹联合腹腔镜阴道骶骨固定术的170例患者的临床资料。结果170例患者均顺利完成手术,无术中并发症。术中出血量(81.2±48.8)mL,术后留置尿管(2.3±1.2)d,术后住院(5.5±1.6)d。术后发热5例(2.94%),对症处理均好转。尿潴留8例(4.71%),再次留置尿管(4±1)d后均无再次出现尿潴留。阴道残端愈合不良1例(0.59%),予抗炎、止血对症支持治疗后痊愈出院,未发生远期并发症。网片暴露6例(3.53%),3例发生在穹隆顶端,1例发生在阴道前壁,2例发生在阴道后壁,所有网片暴露的患者返院行阴道暴露网片清除术,均无二次暴露。肠道并发症2例(1.2%):1例患者术前诊断为直肠前突并轻度直肠黏膜内套叠,术后1年再次出现顽固性肛门坠胀感伴腰骶疼痛,盆腹部MRI未见骶前区液性暗区,排除椎体骨膜炎及椎间盘炎;另1例患者有嗜酸性细胞肠炎病史,围手术前未发生并发症,术后4年出现乙状结肠-阴道瘘,行开腹乙状结肠单腔造瘘+部分乙状结肠切除术+骶前、阴道穹隆清创及网片切除术,术后随访至今未再发生肠道并发症。结论经阴道辅助的腹腔镜阴道骶骨固定术是一种安全可靠的手术方式。Objective To analyze the postoperative complications of vagina-assisted laparoscopic sacrocolpopexy in patients with stageⅢ-Ⅳpelvic organ prolapse and provide real world clinical data for transvaginal mesh implantation surgery.Methods Retrospectively analyze the clinical data of 170 patients who underwent vagina-assisted laparoscopic sacrocolpopexy in the Department of Obstetrics and Gynecology of the First Affiliated Hospital of Guangzhou Medical University from May 2009 to January 2018 for stageⅢ-Ⅳpelvic organ prolapse.Results All the 170 patients were successfully operated and didn’t have any intraoperative complications.The mean intraoperative blood loss was(81.2±48.8)mL,the mean days of postoperative urinary catheterization were(2.3±1.2)d,and the mean postoperative dys of hospital stay were(5.5±1.6)d;5 patients(2.94%)had postoperative fever,which was relieved after symptomatic treatment.Urinary retention occurred in 8 cases(4.71%),no urinary retention occurred after reindwelling catheter(4±1)days.Poor healing of vaginal stump occurred in 1 patient(0.59%),and after anti-inflammatory and hemostatic therapy,the patients were relieved and there were no long-term complications.Mesh exposure occurred in 6 cases(3.53%):three cases of fornix apical mesh,one case of anterior vaginal mesh and two cases of posterior vaginal mesh.All patients with mesh exposure returned to the hospital for vaginal-exposed mesh removal and there was no secondary mesh exposure.Bowel complication occurred in 2 patients(1.2%):in one patient who was diagnosed with rectocele and intussusception,intractable anal bulge sensation with lumbosacral pain occurred 1 year after surgery;pelvic and abdominal MR didn’t show frontal liquid dark area and vertebral periostitis and discitis were excluded;another patient had a history of eosinophilic enteritis,while there was no complication before the operation,sigmoid colon vagina fistula occurred 4 years after the operation.;open sigmoid colon single cavity fistulation plus partial sigmoid

关 键 词：阴腹联合腹腔镜阴道骶骨固定术 盆腔器官脱垂 并发症 

分 类 号：R711.2[医药卫生—妇产科学]