盆底超声联合尿动力学检查对老年女性盆腔脏器脱垂的诊断价值

目的评估盆底超声联合尿动力学检查对老年女性盆腔脏器脱垂(POP)的诊断价值。方法选取2018年1月至2020年6月到海南省妇女儿童医学中心就诊的60例老年POP患者为POP组,并将20例同期就诊的阴道炎患者作为对照组。对POP患者进行尿动力学检查,且依据国际尿控协会(ICS)的盆腔脏器脱垂分期法(POP-Q)对POP患者进行分期。同时对POP患者和志愿者进行盆底超声,检查其在静息状态和最大Valsalva动作时近端尿道与膀胱后壁的夹角(α)、上段尿道与人体纵轴的夹角(β)、膀胱颈到耻骨联合下缘-腹背侧水平线的垂直距离(L)及最大幅度Valsalva动作时膀胱颈移动度(BND)。分析盆底超声和POP-Q检查阴道前壁(Aa)点位置的相关性。结果对60例患者进行了POP-Q分期;尿动力学检查结果显示52例POP组有阴道前壁脱垂、45例有阴道后壁脱垂、37例有子宫脱垂、14例伴有膀胱出口梗阻、16例伴有逼尿肌异常、18例伴有膀胱功能异常。超声结果显示不同POP-Q分期患者的α角、β角、L及BND差异无统计学意义(P>0.05),对照组和POP组超声指标差异有统计学意义(P<0.05)。盆底超声测量值和POP-Q分期与Aa点位置的检测结果具有良好的相关性。结论尿动力学检查和盆底超声对老年POP都具有诊断价值,两者结合可以提高检查的精准性,为老年女性POP的手术方案和术后护理提供可靠的依据。     

生物张力聚焦疗法联合中药艾灸对老年盆腔器官脱垂患者的疗效

目的探讨生物张力聚焦疗法(BFT)联合中药艾灸在老年盆腔器官脱垂(POP)患者中的应用。方法纳入POP-Q分度为Ⅱ度及以下的轻中度患者200例,分为观察组和对照组各100例,观察组采用BFT联合中药艾灸疗法,对照组采用常规盆底肌锻炼疗法,比较两组器官脱垂程度、盆底肌肌力、主观症状及治疗1年后生活质量。结果观察组治疗后POP-Q分级Ⅰ～Ⅱ级的患者明显少于对照组,差异有统计学意义(P0.05),治疗后观察组肌力、盆底功能障碍性疾病症状问卷(PFDI-20)评分、中医证候评分、盆腔脏器脱垂/尿失禁性功能问卷(PISQ-12)及盆底疾病生活质量影响问卷短表(PFIQ-7)评分均较治疗前明显改善,且观察组均明显优于对照组(均P0.01)。结论 BFT联合中药艾灸可有效控制老年POP患者器官脱垂程度,缓解临床症状、提高盆底肌张力、改善患者生活质量。     

阴道部分封闭术治疗老年女性盆腔器官脱垂的临床疗效

目的探讨阴道部分封闭术治疗老年女性盆腔器官脱垂(POP)的安全性及临床疗效。方法回顾性分析南京医科大学附属南京医院2012年6月至2015年12月间51例接受阴道部分封闭术的老年POP病人的临床资料,通过统计围手术期的参数评价手术的安全性,并随访评价手术的主客观疗效。结果 51例病人均安全度过围手术期,手术时间短,术后恢复快。失访5例,46例获随访,术后盆底困扰量表(PFDI-20)评分较术前明显下降(P0.05),有3例(6.5%)病人复发。结论阴道部分封闭术是治疗老年女性POP的一种安全性高、效果良好的手术方式。     

两种术式治疗女性重度盆腔器官脱垂的疗效

目的比较prolift盆底重建系统与传统阴式子宫全切术及阴道前后壁修补术加骶棘韧带悬吊术治疗女性重度盆腔器官脱垂的应用效果。方法回顾分析该院2009年1月至2011年9月治疗患有POP-Q分期Ⅲ～Ⅴ期的患者30例,其中采用prolift盆底重建术14例,其他患者采用传统术式,比较两组患者的手术效果、术后并发症、手术情况(手术时间及出血量),并进行统计学分析。结果 Prolift组手术时间及出血量明显少于阴式子宫全切术及阴道前后壁修补术加骶棘韧带悬吊术组(P<0.05),POP-Q分期评价两组患者术后阴道Aa、Ba、C、Ap、Bp位点均得到显著改善,解剖疗效明显。结论两种术式应用于纠正女性重度盆腔器官脱垂都是安全可行的,但术后复发率、手术时间、手术出血量、手术并发症等方面,pro-lift盆底重建系统优于传统阴式子宫全切术加阴道前后壁修补术及骶棘韧带悬吊术。     

改良阴道旁修补术在盆底重建中的作用

目的 探讨改良阴道旁修补术治疗阴道前壁及膀胱膨出的有效性和安全性.方法 我院自2007年1月至2009年8月采用改良阴道旁修补术治疗52例阴道前壁及膀胱膨出的患者,其中6例患者既往曾行阴道前壁修补术.术后1、3、6、12、24个月定期随访,对手术效果进行主观及客观评价.客观治愈标准定义为阴道残端位于坐骨棘水平.结果 52例患者盆腔器官脱垂定量系统(POP-Q)分期Ⅱ期30例,Ⅲ期17例,Ⅳ期5例.所有患者改良阴道旁修补术均获成功.手术时间为45～110 min,平均(65±18)min,出血量50～200 ml,平均(95±27)ml,无其他手术并发症.随访3～24个月,平均(10.1±3.1)个月,复发6例(11.5%);其中5例为POP-Q分期Ⅰ期,1例POP-Q分期Ⅲ期.结论 改良阴道旁修补术在盆底重建中短期治疗效果稳定,较应用补片手术方法简单,并发症少.     

部分阴道闭合术治疗高龄妇女严重盆腔脏器脱垂临床观察

目的观察部分阴道闭合术治疗高龄妇女严重盆腔脏器脱垂（POP）的疗效。方法老年POP患者28例,POP-Q分度为Ⅱ~Ⅳ度,均采用部分阴道闭合术治疗。结果本组手术顺利,未发生副损伤及并发症。术后尿失禁症状改善12例,排尿困难症状好转8例。术后6个月28例POP均无复发,术后12个月获得随访25例,3例因内科疾病死亡,余22例POP无复发,主观感觉满意。结论部分阴道闭合术治疗高龄妇女严重POP操作简单、安全、疗效较好,复发率低。     

手术治疗盆腔器官脱垂62例疗效观察

目的观察手术治疗盆腔器官脱垂的临床效果。方法盆腔器官脱垂患者62例,经阴道行穹窿单侧骶棘韧带固定术27例,经阴道行子宫骶韧带穹窿悬吊术20例,行腹腔镜下子宫骶韧带穹窿高位悬吊术8例(其中3例保留子宫同时行圆韧带缩短术),行经腹自体筋膜宫颈骶骨固定术7例;如有阴道缺陷,同时进行修补。结果 1例术中骶韧带未能辨认,改行阴道残端骶棘韧带悬吊术;2例因骶棘韧带缝合困难,改单侧髂尾肌筋膜固定术;59例手术顺利;随访1～3 a,1例半年后复发,其余患者POP-Q分期均在Ⅱ期以内。结论手术治疗盆腔器官脱垂疗效满意。     

应用全盆底重建术治疗老年女性重度盆腔器官脱垂临床分析

目的 评价全盆底重建术治疗老年女性重度盆腔器官脱垂的疗效.方法 回顾性分析34例POP-QⅢ～Ⅳ期盆腔器官脱垂行全盆底重建术的老年患者临床资料,评价该手术疗效及对患者生活质量的影响.结果 所有手术均安全顺利进行,未见膀胱、直肠等损伤;手术时间（105±31.2） min,出血（185.4±65.9） mL;所有患者术后4～5d后均自主排尿.随访2年,复发率为0（0/34）;PFIQ评分由术前的（84.3±22.6）分降至术后2年的（11.2±6.5）分,PFDI评分由术前的（75.8±19.4）分降至术后2年的（12.4±5.3）分.结论 全盆底重建术用于纠正老年女性重度盆腔器官脱垂,手术安全,术后生活质量改善明显,值得临床推广应用.     

全盆底网片悬吊术治疗老年妇女盆腔器官脱垂疗效观察

目的观察全盆底网片悬吊术治疗老年妇女盆腔器官脱垂（POP）的疗效。方法对15例同时伴有子宫（穹窿）、阴道前后壁脱垂的POP患者行全盆底网片悬吊术治疗。结果 15例患者手术顺利,手术时间68～150min,术中出血量150～500 ml,无输血病例,无直肠及膀胱损伤。住院时间5～9 d。术后随访1～18个月,盆底结构正常,POP均未复发。4例器官脱垂症状改善,5例腰骶部不适消失,9例便秘消失,11例压力性尿失禁治愈。术后发生网片侵蚀伴阴道分泌物增多症状1例,修剪侵蚀的网片后恢复正常。结论全盆底网片悬吊术治疗老年妇女POP能实现全盆底解剖和功能重建,近期疗效较好。     

磁电联合治疗绝经后女性盆腔器官脱垂的临床疗效观察

目的探讨磁电联合对绝经后女性盆腔器官脱垂(POP)患者的临床疗效。方法采用回顾性研究的方法对42例绝经后女性POP患者的临床治疗结果进行分析。其中观察组(21例)接受电刺激生物反馈联合磁刺激治疗,对照组(21例)仅接受一般健康教育,比较治疗前后POP定量(POP-Q)分级、盆底肌肌力和盆底表面肌电评估所测收缩阶段肌电值的变化。结果对照组治疗后POP-Q分级、盆底肌肌力和盆底表面肌电评估所测收缩阶段肌电值均较治疗前无明显改善(P0.05),但观察组治疗后较治疗前均有明显改善,POP-Q分级降低,盆底肌肌力和盆底表面肌电评估所测收缩阶段肌电值均升高,差异有统计学意义(P0.05)。结论磁电联合治疗对绝经后女性POP患者疗效显著,能明显改善患者的盆底肌力和脱垂程度。     

中老年女性盆腔器官脱垂患者尿动力学检查106例临床分析

目的探讨女性盆腔脏器脱垂（pelvic organ prolapse,POP）的尿动力学特点,了解盆腔脏器脱垂与压力性尿失禁（stress urinary incontinence,SUI）的关系。方法对2006年1月至2009年12月在本院就诊的106例女性盆腔脏器脱垂患者,采用盆腔脏器脱垂评估分类法（pelvic organ prolapse quantitative examination,POP-Q）评估,并进行尿动力学检查,测定尿动力学参数,对结果进行统计学分析。结果 106例盆腔脏器脱垂患者中,合并SUI 76例（Ⅰ型SUI 36例,Ⅱ型24例,Ⅲ型16例）（71.7%,76/106）,混合性尿失禁10例（9.4%,10/106）。结论盆腔脏器脱垂与SUI密切相关。尿动力学检查在女性盆腔脏器脱垂的诊断治疗方面具有重要指导意义。     

The effect of age on short-term outcomes after abdominal surgery for pelvic organ prolapse

OBJECTIVES: To compare perioperative morbidity and 1-year outcomes of older and younger women undergoing surgery for pelvic organ prolapse (POP). DESIGN: Prospective ancillary analysis. SETTING: Academic medical centers in National Institutes of Health, National Institute of Child Health and Human Development Colpopexy and Urinary Reduction Study. PARTICIPANTS: Women with POP and no symptoms of stress incontinence. INTERVENTION: Abdominal sacrocolpopexy with randomization to receive Burch colposuspension for treatment of possible occult incontinence or not. MEASUREMENTS: Perioperative complications and Pelvic Organ Prolapse Quantification and quality-of-life (QOL) questionnaires (Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and Medical Outcomes Study Short-Form Health Survey (SF-36) preoperatively, immediately postoperatively, and 6 weeks and 3 and 12 months postoperatively). RESULTS: Three hundred twenty-two women aged 31 to 82 (21% aged > or =70), 93% white. Older women had higher baseline comorbidity (P<.001) and more severe POP (P=.003). Controlling for prolapse stage and whether Burch was performed, there were no age differences in complication rates. Older women had longer hospital stays (3.1+/-1.0 vs 2.7+/-1.5 days, P=.02) and higher prevalence of incontinence at 6 weeks (54.7% vs 37.2%, P=.005). At 3 and 12 months, there were no differences in self-reported incontinence, stress testing for incontinence, or prolapse stage. Improvements from baseline were significant on all QOL measures but with no age differences. CONCLUSION: Outcomes of prolapse surgery were comparable between older and younger women except that older women had slightly longer hospital stays.     

全骨盆底悬吊术在女性骨盆底功能重建中的应用

目的探讨利用全骨盆底网片悬吊术治疗女性盆腔脏器脱垂并进行骨盆底重建的可行性和有效性。方法对2005年1月至2006年6月确诊为盆腔脏器脱垂的53例患者采用蝶形聚丙烯网片进行经阴道全骨盆底悬吊术,根据临床检查及主诉对手术前后脱垂情况进行评估,观察疗效并定期随访。结果手术时间平均97min,出血量平均160ml,53例均在术后2～6d出院,术后1、3、9、12个月随访,根据国际尿控协会制定的盆腔脏器脱垂定量分度法客观评估子宫脱垂、阴道前后壁膨出等症状全部得到纠正,无复发、无阴道扭曲和缩短、无性生活障碍,满意度达94．3％。结论全骨盆底网片悬吊术是经阴道的微创手术,对盆腔脏器脱垂患者在保留子宫的同时进行骨盆底功能重建,复发率低,值得临床进一步推广。     

Dynamic magnetic resonance imaging used in evaluation of female pelvic prolapse: experience from nine cases

Prolapse of pelvic organs in a female can be simple or complex. To make a definite diagnosis of pelvic prolapse preoperatively, dynamic magnetic resonance (MR) is an alternative to conventional fluoroscopic or sonographic examination, with the advantage of providing greater details, and thus helping the surgeon to have a good preoperative plan. Nine women suffering from pelvic prolapse with or without urinary stress incontinence underwent dynamic MR imaging examination (1.0T Magnex100/HP, Shimadzu, Kyoto, Japan) before surgery. All patients were examined in the supine position. A single-shot ultra-high speed scan (FE/8/3.02-20 degrees, 128, 100%-100% 1 NEX 1 slice 10 mm L1.0 second) was used to obtain midline sagittal images, with the patients at rest and during pelvic strain. MR images were then obtained every 4 seconds. Each examination was analyzed, based on specific measurements, to determine the presence and extent of prolapse of pelvic organs. The pubococcygeal, levator hiatus width and muscular pelvic floor relaxation lines, and the angle of the levator plate were identified. Based on these measurements, multicompartment involvement in the pelvic prolapse was confirmed in five patients (5/9). Four patients (4/9) had single compartment involvement. Seven patients underwent surgery. All patients reported significant improvement in their symptoms and signs after surgical intervention. Two patients had an almost complete recovery. MR demonstrated simple or complex organ descent in all pelvic compartments, and may become a standard preoperative examination for pelvic floor abnormalities. The MR images facilitated comprehensive planning by the surgeon; thus, they can increase the success rate and help to accurately predict the outcome of the surgical intervention. The surgeons also expressed high postsurgical satisfaction with the information provided by dynamic MR.     

Is there a role for concomitant pelvic floor repair in patients with sphincter defects in the treatment of fecal incontinence?

BACKGROUND AND AIMS: More than half of all patients who undergo overlapping anal sphincter repair for fecal incontinence develop recurrent symptoms. Many have associated pelvic floor disorders that are not surgically addressed during sphincter repair. We evaluate the outcomes of combined overlapping anal sphincteroplasty and pelvic floor repair (PFR) vs. anterior sphincteroplasty alone in patients with concomitant sphincter and pelvic floor defects. PATIENTS AND METHODS: We reviewed all patients with concomitant defects who underwent surgery between February 1998 and August 2001. Patients were assessed preoperatively by anorectal manometry, pudendal nerve terminal motor latency, and endoanal ultrasound. The degree of continence was assessed both preoperatively and postoperatively using the Cleveland Clinic Florida fecal incontinence score. Postoperative success was defined as a score of 相似文献   

Pelvic Organ Prolapse-Associated Cystitis

Pelvic organ prolapse (POP) and urinary tract infection (UTI) are important problems, estimated to affect around 14 and 40 % of women, respectively, at some point in their lives. Positive urine culture in the presence of symptoms is the cornerstone of diagnosis of UTI and should be performed along with ultrasound assessment of postvoid residual (PVR) in all women presenting with POP and UTI. PVR over 30 mL is an independent risk factor for UTI, although no specific association with POP and UTI has been demonstrated. The use of prophylactic antibiotics remains controversial. The major risk factors for postoperative UTI are postoperative catheterisation, prolonged catheterisation, previous recurrent UTI and an increased urethro-anal distance—suggesting that global pelvic floor dysfunction may play a role.     

Surgical Management of Pelvic Organ Prolapse in Females: Functional Outcome of Mesh Sacrocolpopexy and Rectopexy as a Combined Procedure

Purpose Urogenital prolapse is relatively common compared with rectal prolapse and the combination of urogenital prolapse and rectal prolapse is still more infrequent. This study was designed to evaluate the functional outcome of a series of patients who have undergone open mesh sacrocolporectopexy surgery for combined vaginal and rectal prolapse. Methods Consecutive patients from June 2000 to June 2004 with confirmed vaginal and rectal prolapse subsequently underwent open mesh sacrocolporectopexy. The Cleveland Clinic Short Form-20 Pelvic Floor Distress Inventory questionnaire with Urinary Distress Inventory, Pelvic Organ Prolapse Distress Inventory, and Colorectal-Anal Distress Inventory subscales was completed by all patients preoperatively and at six months postoperatively. Results There were 29 patients with a median age of 66 (interquartile range, 59–73) years. Median period of follow-up was 26 (interquartile range, 15–33) months. Median global pelvic floor distress inventory scores were lower postoperatively compared with preoperatively (96.4 (interquartile range, 50.8–149.7) vs. 182.3 (interquartile range, 140.6–208.6; P = 0.001). All three median subscales scores also were significantly lower postoperatively compared with preoperatively. Conclusions In patients with concurrent vaginal and rectal prolapse, open mesh sacrocolporectopexy confers good symptomatic improvement for urinary-, vaginal-, and rectal-related symptoms. Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Seattle, Washington, June 3 to 7, 2006.     

Management of pelvic organ prolapse

Symptomatic pelvic organ prolapse can afflict up to 10% of women. Urinary incontinence, voiding dysfunction or difficulty possibly related to bladder outlet obstruction are common symptoms. Infrequently hydronephrosis or defecatory dysfunction can be seen. The management of pelvic organ prolapse (POP) should start with adequate assessment of all pelvic floor complaints. If a patient is not symptomatic, surgical intervention is usually not indicated. While the use of a variety of graft materials are available today including porcine, dermal and synthetic grafts, that are used in some surgical approaches to pelvic organ prolapse, other more conservative approaches may prove beneficial to many patients. This article describes our approach to the patient with pelvic organ prolapse.     

Effects of Pelvic Organ Prolapse on the Bladder

Purpose of Review

To assess how pelvic organ prolapse (POP) and treatment affect bladder function.

Recent Findings

There is significant overlap between POP and bladder symptoms, including urinary incontinence and overactive bladder. POP may result in bladder outlet obstruction (BOO) secondary to urethral kinking, which may result in overactive bladder (OAB), dysfunctional voiding, and occult or de novo stress urinary incontinence (SUI). Improvements in obstructive symptoms and dysfunctional voiding after POP surgery suggest that pelvic floor reconstruction restores pelvic floor anatomic structure and function. Furthermore, correction of anatomic structure also seems to improve OAB symptoms, although a direct causative link has yet to be established.

Summary

Pelvic floor syndromes should be interpreted as a whole. POP, OAB, urinary incontinence, BOO, and dysfunctional voiding are all part of pelvic floor syndromes, coexisting and interacting to manifest different symptoms before and after POP treatment.

     

Overactive Bladder Prevalence after Surgery for Pelvic Organ Prolapse

In this review, we set out to address the clinically complex question of how patients with overactive bladder (OAB) syndrome and pelvic organ prolapse (POP) fare with respect to symptomatic improvement after surgical treatment of POP. Our objectives are to use the current literature to define appropriate patient expectations for improvement and cure and to look for factors predicting divergent outcomes, with the goal of offering realistic preoperative patient counseling. Secondary aims include highlighting areas of needed research, defining outcome measures, and examining theories regarding the relationship between OAB and POP. Relevant original papers and review articles were identified by conducting a literature search using PubMed and Medline. The cause of OAB symptoms and the relationship between vaginal wall prolapse and OAB remain unclear. However, POP repair seems to improve the symptoms of OAB syndrome in 30% to 80% of patients, with a small but significant percentage of patients (≤20%) developing de novo symptoms of OAB.