经阴道植入网片与自体组织盆底重建术治疗重度盆腔器官脱垂的长期效果比较  

Comparison of long-term clinical outcomes between transvaginal mesh and pelvic floor reconstruction with native tissue repair in the treatment of advanced pelvic organ prolapse

作　　者：吴湘[1] 吴菲[1] 蒋静 阳丽[1] 何薇薇[1] 李能[1] 张珂[1] 陈黎 任诗帆 吴静[1] Wu Xiang;Wu Fei;Jiang Jing;Yang Li;He Weiwei;Li Neng;Zhang Ke;Chen Li;Ren Shifan;Wu Jing(Department of Gynecology,Hunan Provincial Maternal and Child Health Care Hospital,Changsha 410008,China)

机构地区：[1]湖南省妇幼保健院妇科,长沙410008

出　　处：《中华妇产科杂志》2023年第8期595-602,共8页Chinese Journal of Obstetrics and Gynecology

基　　金：湖南省科技厅临床医疗技术创新引导项目(2020SK50603)。

摘　　要：目的比较经阴道植入网片盆底重建术(TVM)与自体组织盆底重建术(NTR)治疗重度盆腔器官脱垂(POP)的长期临床效果。方法选取2016年1月至2019年9月在湖南省妇幼保健院诊治的207例重度POP患者,按盆腔器官脱垂定量(POP-Q)分度法分度均在Ⅲ度及以上,同时伴有临床症状。根据手术方法的不同分为TVM组和NTR组,TVM组为经阴道植入网片进行盆底重建术,NTR组则采用传统经阴道子宫切除加宫骶韧带悬吊加阴道前后壁和会阴体修补术。术后中位随访时间为60个月(范围:41~82个月),完成随访164例(79.2%,164/207),其中TVM组76例、NTR组88例。比较两组患者围手术期指标和并发症发生率,同时随访两组术后1、3、5年时的主、客观治疗效果。客观疗效采用手术成功的3项复合标准,即:(1)阴道前后壁脱垂最远端距离处女膜≤0 cm,同时顶端下降距离≤1/2阴道全长;(2)根据“经常看到或感到阴道有肿物脱出吗?”判定相关的POP症状消失;(3)未因脱垂而再行手术或子宫托治疗;同时满足以上3条标准者为手术成功(即客观治愈),反之为复发(术后3个月及以后)。主观疗效评价采用盆底不适调查表简表(PFDI-20)和盆底功能影响问卷简表(PFIQ-7)评分。结果术后5年TVM组患者的主观、客观治愈率分别为89.5%(68/76)和94.7%(72/76),NTR组的主观、客观治愈率分别为80.7%(71/88)和85.2%(75/88),TVM组的主客观治愈率均显著高于NTR组,分别比较,差异均有统计学意义(χ^(2)=9.869,P=0.002;χ^(2)=3.969,P=0.046)。TVM组患者的复发率为5.3%(4/76),NTR组为14.8%(13/88),TVM组的复发率显著低于NTR组(P=0.046)。两组患者的术后PFDI-20和PFIQ-7评分均较术前明显降低(P均<0.05)。TVM组的网片暴露率为1.3%(1/76)。结论本研究的TVM与NTR长期比较结果显示,TVM治疗重度POP的长期主客观疗效均显著优于NTR,复发率显著低于NTR,提示TVM对治疗重度POP有一定的优势。Objective To study the long-term clinical effect of transvaginal mesh(TVM)and pelvic floor reconstruction with native tissue repair(NTR)in the treatment of advanced pelvic organ prolapse(POP).Methods Totally 207 patients with advanced POP who were treated in Hunan Provincial Maternal and Child Health Care Hospital from Jan.2016 to Sep.2019 were enrolled.The patient′s pelvic organ prolapse quantification were all at degreeⅢor above,and they all complained for different degree of symptoms.They were divided into two groups according to the different surgical methods,TVM group and NTR group.In TVM group,the mesh was implanted through the vagina for pelvic floor reconstruction,while in NTR group,the traditional transvaginal hysterectomy combined with uterosacral ligament suspension and anterior and posterior wall repair,as well as perineal body repair were performed.The median follow-up time was 60 months,during the follow up time,164 cases(79.2%,164/207)had completed follow-up,including 76 cases in TVM group and 88 cases in NTR group.The perioperative data and complication rates of the two groups were compared,and the subjective and objective outcomes of the two groups at 1,3 and 5 years were observed,respectively.The objective efficacy was evaluated by three composite criteria,namely:(1)the distance from the farthest end of the prolapse of the anterior and posterior wall of the vagina to the hymen is≤0 cm,and the descending distance of the top is≤1/2 of the total length of the vagina;(2)determine the disappearance of relevant POP symptoms according to“Do you often see or feel vaginal mass prolapse?”;(3)no further operation or pessary treatment was performed due to prolapse.If the above three criteria were met at the same time,the operation is successful;otherwise,it was recurrence.The subjective efficacy was evaluated by the pelvic floor distress inventory-short form 20(PFDI-20)and pelvic floor impact questionnaire-short form 7(PFIQ-7).Results The median follow-up time of the two groups was 60 months(ran

关 键 词：盆腔器官脱垂 聚丙烯类 外科网 骨盆底 妇科外科手术 治疗结果 

分 类 号：R713[医药卫生—妇产科学]