盆腔器官脱垂手术的复发与对策  

Recurrent pelvic organ prolapse and strategic management after surgery.

作　　者：鲁永鲜[1] LU Yong-xian(Senior Department of Obstetrics&Gynecology,the Fourth Medical Center of PLA General Hospital,Bejing 100048,China)

机构地区：[1]中国人民解放军总医院妇产医学部第四医学中心,北京100048

出　　处：《中国实用妇科与产科杂志》2023年第3期289-295,共7页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：国家重点研发计划(2021YFC2009100)。

摘　　要：盆腔器官脱垂(POP)术后复发率仍高。患者自身多种高危因素以及手术因素(如未鉴别出与POP复发相关的盆腔所有缺陷部位,未予以修补、术式选择不当、手术者的专科训练及对手术的掌握程度不足等)都是明确导致手术复发的高危因素。有些POP手术复发的原因是多种因素结合叠加所导致的,有些危险因素已经明确,但还有很多危险因素尚未充分了解。保守治疗和手术是复发后的主要治疗对策,前者主要针对不能耐受再手术者,可缓解症状;后者可根本解决及纠正复发。POP复发手术困难,必要时需网片加固,应由受过亚专科训练并有处理复发患者丰富临床经验的术者实施,才可能达到最好的临床结果。There is still a high recurrence rate of pevic organ prolaps(POP)after suryery.The patients themselves may have multiple high recurrent risks.Inadiquate surgery,unidentified related all the pelvic defects and not repair them or the procedures choosed not correctly,surgeons training are not enough and can not master the procedures are all high reisk factors,which may result in recurrence of the POP surgery.We have known some definite risk fators,but for some others we haven’t know them well.Forthermore,some recurrence of POP surgery is caused by the combination of multiple factors.Severity,location and bothersome symptom of POP should be assessed before the reoperation.For the treatment strategies of recurrent POP,there are two methods.One is conservative measures,and the other is reoperation.The former can relieve the symptoms and postpone POP progression,and the latter can solve and correct recurrent POP.The repeat operation for recurrent POP is difficult and there is no high lever evidence to support what is the best procedure.The individual procedure based on the characteristics of recurrent POP should be designed.At the present it is recommended that abdominal sacrocolopopexy or transvaginal mesh could be chosen as relatively better precedure for the recurrent POP.The mesh may be needed to reinforce the repairment.Any surgical procedure should be carried out by subspecialtized trained and experienced surgeons with an adequate clinical experience and good results.It is necessary sometimes to need Multidisciplinary consultation and joint management.

关 键 词：盆腔器官脱垂 手术 复发 预防 治疗 

分 类 号：R711.2[医药卫生—妇产科学]