盆底修复系统治疗盆腔脏器脱垂的疗效分析和安全性探讨  

Safety and efficacy of pelvic reconstruction system for the treatment of pelvic organ prolapse

作　　者：陈汝君 陆伟[1] 李怀芳[1] 童晓文[1] CHEN Rujun;LU Wei;LI Huaifang;TONG Xiaowen(Department of Gynaecology and Obstetrics,Tongji Hospital of Tongji University,Shanghai 200240,China)

机构地区：[1]同济大学附属同济医院妇产科,上海200240 [2]复旦大学附属上海市第五人民医院妇产科

出　　处：《上海医学》2020年第8期459-465,共7页Shanghai Medical Journal

摘　　要：目的探讨应用盆底修复系统(Avaulta系统)治疗盆腔脏器脱垂(POP)的安全性和有效性。方法选择2014年2月—2015年3月在同济大学附属同济医院因POP需行手术治疗的66例患者,并应用Avaulta系统对患者行盆底重建手术。完善术前准备,记录患者围术期评价指标;于术后6周、3个月、6个月进行门诊随访,对比术前与术后各时间点患者盆腔脏器脱垂定量(POP-Q)分期、并发症发生情况;通过盆底功能影响量表(PFIQ-7)和盆腔脏器脱垂生活质量量表(P-QOL)评估患者术前、术后6个月盆底功能和生活质量改善情况。结果纳入患者年龄为(64.36±9.20)岁,体重为(60.72±8.78)kg,身高为(157.67±4.87)cm;术前POP-Q分期为Ⅱ期6例、Ⅲ期46例和Ⅳ期14例;行前盆腔盆底重建手术59例,行后盆腔盆底重建手术5例,行全盆腔盆底重建手术2例;术中联合行经阴道和闭孔尿道中段无张力悬吊术(TVT-O)1例,行全子宫切除术6例,行宫颈切除术3例。术后6周失访2例,术后3个月失访6例,术后6个月失访7例,完成随访患者59例。患者手术时间为(51.79±29.58)min,无术后并发症发生;术后次日,患者外周血血红蛋白值、血尿发生率、ALT和AST水平与术前相比,差异均无统计学意义(P值均>0.05)。均于术后3 d拔除导尿管,2例患者出现排尿困难,予重置导尿管2周后拔除;术后6周,1例患者发生局部感染,予甲硝唑栓抗感染治疗。术后患者疼痛总发生率为17.19%(11/64),多数可自行缓解。术后6个月,5例患者新发压力性尿失禁,症状较轻,未予特殊处理。术后6个月,4例患者出现便秘,予口服缓泻剂、开塞露通便后症状缓解。术后6周,患者POP-Q分期均<Ⅱ期,2例为Ⅰ期,治疗有效率为100.00%(64/64);术后3个月,1例患者POP-Q分期为Ⅱ期,5例为Ⅰ期,治疗有效率为98.33%(59/60);术后6个月,1例患者POP-Q分期为Ⅱ期,6例为Ⅰ期,有效率为98.31%(58/59);术后多数患者盆底解剖形态较术前显著恢�Objective To verify the safety and efficacy of pelvic floor reconstruction system(Avaulta system)for pelvic organ prolapse(POP).Methods A total of 66 POP patients treated surgically by Avaulta system from February 2014 to March 2015 were enrolled in this study.Clinical parameters during operation were recorded.Outpatient follow-up was conducted at 6 weeks,3 months and 6 months after surgery.Pelvic organ prolapse quantitative examination(POP-Q)and complications in these patients were analyzed.Pelvic floor function and quality of life were evaluated by using pelvic floor impact questionnaire-short form 7(PFIQ-7)and pelvic organ prolapse quality of life questionnaire(P-QOL)before surgery and 6 months after surgery.Results The patients were(64.36±9.20)years old,weighed(60.72±8.78)kg,and had a height of(157.67±4.87)cm.There were 6 patients with POP stageⅡ,46 patients with stageⅢ,and 14 patients with stageⅣ.Anterior pelvic floor reconstruction was performed in 59 patients,posterior pelvic floor reconstruction in 5 patients,and whole pelvic floor reconstruction in 2 patients.Additionally,tension-free vaginal tape-obturator(TVT-O)was done in one patient,total abdominal hysterectomy in 6 patients and radical trachelectomy in 3 patients.A total of 59 patients were finally followed up(lost to follow-up:2 cases at 6 weeks postoperatively,6 cases at 3 months and 7 cases at 6 months).The mean operation time was(51.79±29.58)min.No postoperative complications occurred.The incidence of hematuria,the levels of hemoglobin,alanine aminotransfease and aspartate transaminase at the next day after operation were not statistically different from those before surgery(all P>0.05).Urethral catheter was removed 3 days after surgery in all patients.Two patients had difficulty in urinating,and the catheter was used again and removed 2 weeks later.After 6 weeks,one patient had local infection and was treated with metronidazole.The total incidence of postoperative pelvic pain was 17.19%(11/64),and the pain in most patients was able to

关 键 词：骨盆底 盆腔脏器脱垂 妇科外科手术 网片 生活质量 盆底功能恢复 

分 类 号：R713[医药卫生—妇产科学]