改进盆底重建手术对下尿路症状的影响

目的探讨盆腔器官脱垂患者行改进盆底重建手术后排尿情况及下尿路症状的变化,以及术中合用经闭孔尿道中段无张力悬吊手术（TVT-O吊带及TVT-O网片吊带）对活动后漏尿及下尿路症状的影响。方法前瞻胜研究盆腔器官脱垂（POP）患者112例,合并或不合并下尿路症状,行改进盆底重建手术前、术后排尿状况及生活质量。结果①86例随访半年的患者中,术前84．9％（73／86）有下尿路症状,术后有下尿路症状者50％（43／86）,较术前症状改善或消失者76．7％（56／73）;47例随访达1年,下尿路症状改善者59．6％（28／47）。②盆底功能障碍调查问卷PFDI、UDI评分术前术后比较,有统计学意义（P〈0．05）。③单纯改进盆底重建术、改进盆底重建手术与TVT-O联合使用,均可改善下尿路症状（P〈0．05）,加用TVT-O效果优于单纯改进盆底重建术（P〈0．05）。结论①改进盆底重建手术对盆腔器官脱垂患者的下尿路症状有改善作用;②对于术前有活动后漏尿或隐匿性压力性尿失禁的患者,加用TVT-O手术比单纯改进盆底手术能更有效的治疗排尿症状。     

"协和"全盆底重建术治疗重度盆腔器官脱垂的多中心前瞻性研究

目的 探讨"协和"全盆底重建术治疗重度盆腔器官脱垂(POP)的疗效及对患者生命质量和性生活质量的影响.方法 自2006年6月至2008年12月,在全国8家医疗单位开展多中心前瞻性研究,包括北京协和医院、复旦大学附属妇产科医院、北京大学第一医院、北京大学第三医院、第三军医大学西南医院、四川大学华西第二医院、北京大学人民医院、北京妇产医院,共277例POP患者参加本研究,所有患者术前均为Ⅲ度或Ⅳ度.总结研究的中期结果,通过术后随访患者的POP分度情况了解POP的解剖学改善情况.通过比较患者术前、术后盆底功能影响问卷简表(PFIQ-7)和盆底不适调查表简表(PFDI-20)评分,评估手术对患者生命质量的影响;通过比较术前、术后POP-尿失禁性生活问卷(PISQ)评分,评价手术对患者性生活质量的影响.结果 中位随访时间14个月(6～28个月),23例患者术后复发,复发率为8.3%(23/277).19例(6.9%,19/277)患者在随访中发现网片暴露或侵蚀.术后新发的尿失禁为18例(6.5%,18/277).277例患者术前、术后6个月、术后1年的PFIQ-7评分分别为(66.9±65.1)、(7.2±26.7)、(7.6±31.6)分,PFDI-20评分分别为(75.8±49.0)、(17.4±25.2)、(15.0±22.6)分,术后较术前生命质量评分显著降低,差异均有统计学意义(P＜0.01).术前、术后6个月、术后1年的PSIQ评分分别为(76.6±15.4)、(75.5±14.5)、(73.6±12.6)分,术前与术后比较,差异无统计学意义(P＞0.05),手术对性生活质量无明显影响;但术后9例(11%,9/80)患者新发性交痛.结论 "协和"全盆底重建术是治疗重度POP一种有效、安全的手术,可以明显改善患者的生命质量,与传统的全盆底重建术疗效相当.

Abstract：

Objective To evaluate clinical efficiency and quality-of-life outcomes in treatment of severe pelvic organ prolapse by the "Xiehe" pelvic floor reconstruction surgery. Methods From Jun. 2006 to Dec. 2008, 277 severe pelvic organ prolapse patients with stage Ⅲ to Ⅳ from 8 hospitals in China were enrolled in this prospective study. Pelvic organ prolapse quantitative examination (POP-Q) and anatomic improvement in these patients after surgery were analyzed in this interim study. Comparisons of pelvic floor impact questionnaire-short form 7 (PFIQ-7) and pelvic floor distress inventory-short form 20 (PFDI-20) in these patients before and after surgery was used to evaluate quality of life. Comparison of pelvic organ prolapse-urinary incontinence sexual questionnaire (PISQ) in these patients before and after surgery was used to evaluate quality of sexual life. Results With a median follow-up of 14. 0 months (6 -28 months),twenty-three patients showed recurrent prolapse (8. 3%, 23/277), and anatomical success ( ＜ stage 2 in the treated compartment) was 91.7% (254/277). In this series, mesh exposure or erosion rate was 6. 9% (19/277). The postoperative de novo stress incontinence rate was 6. 5% (18/277). The scores for PFIQ-7 and PFDI-20, and its subscales were significantly improved, the scores of before treatment were lower than those after treatment (P ＜0. 01 ). And there was no significant difference in the average score of PISQ before and after the surgery (76. 6 ± 15.4 versus 75.5 ± 14. 5 versus 73.6 ± 12. 6, P ＞0. 05 ), but the rate of de novo dyspareunia was 11% (9/80). Conclusions "Xiehe" pelvic floor reconstruction surgery was safe and efficacy in treatment of pelvic organ prolapse. It could improve quality of life remarkably with less cost when compared with the traditional total pelvic floor reconstruction surgery.     

妇科泌尿学与盆底重建外科:过去、现在与将来(之二)

盆腔器官脱垂(pelvic organ prolapse,POP)是盆底支持结构缺陷、损伤与功能障碍造成的主要后果,它与压力性尿失禁(stress urinary incontinence,SUI)也有密切关系。对POP的诊治是妇科泌尿学与盆底重建外科(urogynecology and reconstructive pelvic surgery,URPS)的基本内容。     

盆腔器官脱垂患者术前尿动力学检查的价值探讨

目的探讨尿动力学检查(UDS)在盆腔器官脱垂(POP)患者中的应用价值。方法回顾性分析2012年1月至2013年12月在北京大学人民医院妇科接受盆底重建手术的348例POP患者的临床资料。根据是否同时合并压力性尿失禁(SUI)将患者分为POP+SUI组和单纯POP组。结果 1 348例POP患者中,142例(40.8%)合并SUI,其中111例患者术前接受UDS检查,但仅有52.3%(58/111)的患者表现为尿动力学SUI(UDS-SUI)。196例单纯POP组患者中,158例行术前UDS检查,8例(5.1%)表现为UDS-SUI,提示隐匿性SUI。2 POP+SUI组中,73例同时行抗尿失禁手术,69例未同时行抗尿失禁手术,术后SUI持续或加重者分别为4.1%(3/73)和29.0%(20/69)。单纯POP组中193未行预防性抗尿失禁手术,术后53例出现不同程度SUI,术后新发SUI(De novo SUI)27.5%(53/193)。单纯POP组中,3例UDS-SUI患者接受抗利尿手术,术后无SUI;5例未行抗尿失禁手术者术后均出现SUI症状。结论对于POP合并单纯SUI患者,无论UDS是否见腹压漏尿,均推荐盆底重建手术同时行抗尿失禁手术,因此术前可不做UDS检查。术前无SUI症状者UDS有助于发现隐匿性SUI,指导手术方式选择,推荐行UDS检查。POP合并复杂下尿路症状者应接受UDS检查。     

改良腹腔镜下阴道骶骨固定术对重度盆腔器官脱垂下尿路症状影响研究

目的探讨重度盆腔器官脱垂患者行改良腹腔镜下阴道骶骨固定术后下尿路症状的变化情况以及术中加行尿道中段无张力悬吊术(TVT/TVT-O)对下尿路症状的改善情况。方法回顾性分析2009年1月至2014年9月因重度盆腔器官脱垂在广州医科大学附属第一医院行改良腹腔镜下阴道骶骨固定术的88例患者,其中81例患者完成术后随访,通过患者最近一次随访情况,分析手术后患者的下尿路症状变化情况;同时评估TVT/TVT-O与该术式同期实施对患者下尿路症状的改善情况。结果 (1)81例患者尿频、尿急手术后发生率低于术前(P0.05),且术后症状有明显改善,改善率分别为80.0%、85.7%;咳嗽漏尿、点滴漏尿、排尿困难、排尿不尽的术后改善率分别为71.4%、83.3%、100%、90.1%,这4种症状的术后新发率分别为28.3%、8.0%、8.0%、15.7%,手术前后的发生率比较,差异无统计学意义(P0.05)。(2)36例术前有压力性尿失禁或隐匿性尿失禁的患者,同期行TVT/TVT-O与单纯行腹腔镜下阴道骶骨固定术各18例,前者下尿路症状中咳嗽漏尿有明显改善(P0.05),术后新发咳嗽漏尿发生率为0,其他下尿路症状的发生率以及手术前后排尿困扰量表(UDI-6)评分相比,差异均无统计学意义(P0.05)。结论改良腹腔镜下阴道骶骨固定术明显改善重度盆腔器官脱垂患者的尿频、尿急症状,术后出现的尿路症状以压力性尿失禁为主。对于术前有漏尿症状或隐匿性尿失禁的患者,加用TVT/TVT-O可明显改善压力性尿失禁症状。     

妇科泌尿学与盆底重建外科:过去、现在与将来(之一)

妇科泌尿学与盆底重建外科(urogynecology and reconstructive pelvic surgery,URPS)业已成为新的学科,立于医学之林。它旨在研究由于盆腔支持结构缺陷、损伤及功能障碍造成的症状、疾患的诊断与处理,其主要问题是女性压力性尿失禁(stress urinary incontinence,SUI)和盆腔器官膨出(pelvic organ prolapse,POP)。据调查表明,50％以上的妇女会有     

三种手术治疗重度盆腔器官脱垂的疗效观察及其复发因素分析

目的 比较"协和"全盆底重建手术、传统的阴式子宫全切除+阴道前后壁修补术、阴式子宫全切除+阴道前壁旁侧修补+骶棘韧带固定+阴道后壁"桥式"缝合+会阴修补术等3种手术治疗重度盆腔器官脱垂的疗效,探讨"协和"全盆底重建手术的临床应用价值.方法 选择重度盆腔器官脱垂,同时合并至少两个部位盆腔缺陷且需要手术的患者173例,86例(A组)采取植入聚丙烯网片材料,行"协和"全盆底重建手术,58例(B组)采取传统手术(阴式子宫全切除+阴道前后壁修补术),29例(C组)采取阴式子宫全切除+阴道前壁旁侧修补+骶棘韧带固定+阴道后壁"桥式"缝合+会阴修补术.比较术前、术中及术后情况,以问卷评分随访术后性生活及生命质量满意度,并分析复发影响因素.结果 (1)3组的手术时间、术中出血量、住院天数及术后病率,两两比较,差异均无统计学意义(P＞0.05).(2)住院费用:A组为(11448±3049)元,B组为(7262±1607)元,C组(7140±1817)元,A组明显多于B、C两组(P＜0.05).(3)术后阴道深度:A组[(7.5±1.4)cm]和C 组[(7.1±0.6)cm]长于B组[(5.6±1.1)cm],分别比较,差异均有统计学意义(P＜0.05).阴道宽度:A组[(4.3±0.3)cm]宽于B组[(3.4±0.3)cm]、C组[(3.3±0.4)cm],分别比较,差异均有统计学意义(P＜0.05).(4)术后12个月复发:A组的复发率12.8%(11/86)与C组的17.2%(5/29)相仿(P＞0.05),明显低于B组的36.2%(21/58),分别比较,差异均有统计学意义(P＜0.05).术后12个月内性生活保持率:A组为16.3%(14/86)明显高于B组的1.7%(1/58)和C组的0,分别比较,差异均有统计学意义(P＜0.05).术后12个月生命质量改善效果:A组[(48±12)分]与C组[(53±16)分]相当(P＞0.05),但均高于B组[(27±9)分],分别比较,差异均有统计学意义(P＜0.05).(5)A组6例网片排异均为阴道后壁,均发生于术后3个月内;B、C组无排异发生.术后新发尿潴留、尿失禁的发生率3组间比较,差异均无统计学意义(P＞0.05).(6)严重盆底功能障碍、传统手术方式、前盆腔缺陷、开展盆底重建手术的初期均为术后复发的高危因素(P均＜0.05).结论 "协和"全盆底重建手术保持了盆底解剖结构及功能完整性,具有疗效满意、术后复发率低、术后性生活及生命质量满意的特点;骶棘韧带固定+阴道前壁旁侧修补+阴道后壁"桥式"缝合+会阴修补术也有一定的疗效.

Abstract：

Objective To investigate clinical significance and application of modified pelvic floor reconstruction developed by Peking Union Medical College Hospital ( MPFR ) in treatment of severe pelvic organ prolapse (POP) by comparing the effectiveness, quality of postoperative sexual life, life satisfaction and risk factors for POP recurrence with the following two surgical procedures: traditional total vaginal hysterectomy with anterior-posterior colporrhaphy (TVH-APC) and total vaginal hysterectomy with lateral colporrhaphy and sacrospinous ligament fixation and vaginal bridge repair and episiotomy (TVH-LC-SSLFVBR-EP). Methods Totally 173 patients with severe POP and at least two compartments defects of pelvic floor underwent surgeries in the study, 86 patients (group A) were treated by MPFR with polypropylene mesh application, 58 (group B) were treated by TVH-APC, and 29 patients (group C) were treated by TVH-LC-SSLF-VBR-EP. Peri-operative data and outcomes of postoperative courses at 6, 12, 18 months were collected and analyzed, in the meantime, the risk factors of recurrence were studied. Results (1) No statistical difference was observed among the above 3 groups in terms of length of operation, amount of blood loss, length of hospital stay, and morbidity after surgery ( P ＞ 0.05). ( 2 ) Cost hospitalization was ( 11 448 ±3049) Yuan in group A, which was significantly higher than (7262 ± 1607) Yuan in group B and (7140 ± 1817 ) Yuan in group C (P ＜ 0.05 ). (3) The length of vaginal cuff of (7.5 ± 1.4) cm in group A and ( 5.6 ± 1.1 ) cm in group C were significantly longer than (7.1±0.6) cm in group B ( P＜0.05). The width of vaginal cuff of (4.3±0.3) cm in group A was larger than (3.4±0.3) cm in group B and (3.3±0.4) cm in group C (P＜0.05). (4) The recurrence rate at 12 months after surgery was 12.8% (11/86)in group A, which was similar with 17.2%(5/29) in group C (P＞0.05) and significantly less than 36.2% (21/58) in group B (P＜0.05). The rate of active sexual life of 16.3% (14/86) in group A was significantly higher than 1.7% (1/58) in group B and 0 in group C ( P ＜ 0. 05 ). The index of life quality improvement at 12 months after surgery was 48±12 in group A, which was no less than 53±16 in group C ( P＞0.05) and higher than 27 ± 9 in group B ( P＜0.05). (5 ) Mesh rejection was observed in 6 patients in group A within 3 months after surgery, while the posterior vaginal wall was exclusively involved. No difference was found in urinary retention or urinary incontinence among three groups (P ＞0. 05 ). (6) The severe degree of POP, type of surgical procedure ( TVT-APC), anterior compartment defect of pelvic floor,and early days of performing pelvic floor reconstruction surgeries were high risk factors for POP recurrence (P＜ 0.05). Conclusions MPFR has a better curative effect and lower recurrence rate on patients with POP. It can help patients regain integrity of anatomical structure and functions of pelvic floor. TVH-LCSSLF-VBR-EP is also effective.     

经阴道网片植入手术治疗盆腔器官脱垂的临床分析

目的 评价经阴道网片植入手术治疗盆腔器官脱垂的疗效及并发症.方法 2007年2月-2009年1月在北京大学第三医院因盆腔器官脱垂Ⅲ～Ⅳ度[据盆腔器官脱垂定量(POP-Q)分度法]采用经阴道网片植入手术的住院患者共66例,术后随访观察疗效指标,以主观症状和POP-Q测量评价主观和客观治愈率、复发率,以盆底不适调查表短表20(PFDI-20)评价手术前后患者的生命质量情况,并对并发症进行总结分析.结果 66例患者中成功放置网片65例;术后随访率为97%(63/65),随访时间为17.2个月(12～25个月).术后6个月、12个月时的主观、客观治愈率均为97%(61/63).51例完成生命质量评价,PFDI-20评分术前、术后6个月、12个月分别为(102±50)、(16±21)和(15±20)分,手术前后比较,差异均有统计学意义(P＜0.05).术中脏器损伤2例;术后复发2例,发生网片相关并发症4例,新发重度尿失禁1例.6例患者接受了二次手术,二次手术后症状缓解或治愈并无复发.结论 经阴道网片植入手术治疗盆腔器官脱垂疗效好,术中并发症发生率低,网片相关并发症经二次手术处理后效果较好.

Abstract：

Objective To evaluate clinical outcome and complications of mesh-augmented vaginal reconstructive surgery in treatment of pelvic organ prolapse. Methods From Feb 2007 to Jan 2009, meshaugmented vaginal reconstructive surgery were performed on 66 women with pelvic organ prolapse stage Ⅲ-Ⅳ. Pre and postoperative symptoms, pelvic organ prolapse quantitation (POP-Q) stage and pelvic floor distress inventory-short form 20 (PFDI-20) measurements were studied to assess anatomic and quality-of-life outcome. Operative complications were also analyzed. Results Totally 65 patients underwent successful surgeries. The rate of follow-up was 97% (63/65) with a median follow-up of 17. 2 months. Subjective cure rate and objective cure rate were both 97% (61/63) at 6 and 12 months after surgeries, 51 women completed PFDI-20 measurements and scores were 102 ± 50 before surgery, 16 ± 21 at 6 months and 15 ± 20 at 12 months. It reached statistical difference when scores were compared before and after surgeries ( P ＜0. 05). Among 66 patients, 2 patients underwent organ injuries, 2 had recurrent prolapse, 4 had meshrelated complications and 1 had severe de novo stress urinary incontinence. Six patients underwent second surgery. Conclusions Mesh-augmented vaginal reconstructive surgery in treatment of pelvic organ prolapsed brought satisfied clinical outcome. The incidence of mesh-related complications was low and secondary operative interventions were effective.     

Prolift网片联合尿道中段悬吊治疗POP或合并SUI患者的近期疗效

目的:探讨全阴道修复网片(total vaginal mesh,TVM)即Gynecare Prolift网片修复系统及联合经闭孔无张力阴道吊带(tensiongfree vaginal tape-obtutor,TVT-O)尿道中段悬吊手术治疗盆腔器官脱垂(pelvic organ prolapse,POP)或合并压力性尿失禁(stress urinary incontinence,SUI)的近期疗效。方法:选择Ⅱ度以上子宫和(或)阴道壁脱垂患者24例,其中本次手术前已切除子宫5例,术中同时切除子宫12例,保留子宫7例。16例用全盆底修复网片(total Prolift),8例用前盆修复网片(anterior Prolift);10例因合并压力性尿失禁同时行TVT-O尿道中段悬吊术。结果:24例患者术中均无严重并发症发生,3例(12.5%)出血量超过500ml;术后随访12～20个月,1例至术后10个月时发现阴道壁网片侵蚀(4.2%,1/24),经门诊4次修剪好转;24例患者均无复发。结论:用Prolift盆底修复网片系统进行盆底重建术,手术安全、易行、微创,近期疗效肯定;合并SUI者同时使用TVT-O不增加手术难度和并发症的发生率。     

盆底功能障碍研究中的调查问卷

盆底功能障碍(pelvic floor dysfunction,PFD)主要包括尿失禁(urinary incontinence,UI)、大便失禁(fecal incontinence,FI)和盆腔器官脱垂(pelviv organ prolapse,POP)3种疾病,在临床上,PFD表现为一组疾病症候群,其症状轻重和对患者生活质量(quality of life,QoL)的影响与解剖学改变有密切的关系,但又不完全相关.目前,调查问卷已成为PFD诊治研究中评价PFD症状及生活质量的重要工具.     

盆底功能障碍性疾病尿动力学检查及临床应用价值

尿动力学如尿流率及膀胱测压等主要用于下尿路功能障碍的膀胱功能和尿道功能检测,盆腔器官脱垂的患者多合并各种下尿路症状,术前行膀胱测压对于复杂性尿失禁和合并盆腔器官脱垂的患者有重要的临床价值。     

Colpocleisis and urinary incontinence

OBJECTIVE: The study was undertaken to review results of colpocleisis performed for advanced pelvic organ prolapse (POP) in elderly women, with attention to perioperative stress incontinence. STUDY DESIGN: We performed a retrospective chart review of all colpocleisis procedures performed July 2000 through March 2002. RESULTS: Sixty-four women with median age 78 years (68-90 years) with symptoms and signs of advanced POP underwent partial vaginectomy and colpocleisis. Concomitantly, 21 (33%) women underwent suburethral sling and 12 (19%) underwent suburethral plication procedures for treatment of stress urinary incontinence (SUI). Three patients with dementia were unable to offer subjective symptoms. One patient died in hospital from multisystem organ failure unrelated to colpocleisis. When last seen, 2 (3%) of the remaining 60 patients had some persistence of symptoms of POP. Of 30 women without preoperative symptoms of SUI, 8 had new-onset SUI symptoms after surgery. CONCLUSION: Colpocleisis is an effective method for treatment of advanced POP. Lower urinary tract evaluation and treatment remain challenging in this setting.     

Tension-free vaginal tape procedure with manual-tapping method: a potentially useful technique

AIM: Stress urinary incontinence (SUI) is accompanied by pelvic organ prolapse (POP) in many cases. We investigate a procedure to adjust the level of suspension of the mid-urethra using tension-free vaginal tape (TVT) under general anesthesia at the time of POP repair surgery. METHODS: Preliminary examination carried out prior to this study showed that the pressure stress applied by a surgeon is less than half of that induced using the cough-stress method: the manual-tapping method (MTM) showed an average intravesical urinary leak point pressure (IULPP) of 21.4 mmHg (range 19-23 mmHg), when the cough-stress method demonstrated an average IULPP >52.4 mmHg (range 45-58 mmHg; n = 3). An attempt was made to predict postoperative SUI by packing sponge gauze into the manually replaced vagina preoperatively. If SUI appeared, TVT was added to the repair operation for POP in those patients (n = 11). Lastly, the MTM was used to decide the level of urethral suspension during the TVT procedure following POP repair surgery under general anesthesia (n = 11). RESULTS: Eleven patients underwent the TVT procedure combined with POP repair surgery. The mean postoperative follow-up period was 23.8 months (range 9-40 months). There was no case of post-surgical ischuria. One patient showed a cystocele during the postoperative course. However, all other patients were relieved from the symptoms of POP, and none complained of SUI following the procedure. CONCLUSION: The MTM seems to be a more appropriate indicator by which to adjust the level of urethral suspension during the TVT procedure than the conventional method, particularly under general anesthesia. To prevent and cure perioperative SUI, the MTM as a TVT procedure combined with POP repair surgery under general anesthesia is a useful procedure.     

应客观评价腹腔镜在盆底重建手术中的应用

女性盆底疾病主要包括压力性尿失禁和盆腔脏器脱垂,手术是其主要的治疗方法。腹腔镜在盆底重建手术中的应用越来越广泛,目前常用的有腹腔镜下膀胱颈悬吊术(Burch),阴道旁侧修补术,骶前阴道固定术,子宫骶骨韧带缩短固定术和腹腔镜下骶棘韧带悬吊术。与经阴道和开腹手术相比,腹腔镜手术有一定优势,但也有一定的局限性,应客观评价。     

压力性尿失禁及盆底组织膨出患者肛提肌肌纤维直径和分型的研究

目的　探讨压力性尿失禁 (stressurinaryincontinence ,SUI)患者肛提肌肌纤维直径和分型的变化及其与SUI和盆底组织膨出 (pelvicorganprolapse ,POP)发病的关系。 方法　选择 15例SUI患者 (SUI组 )、19例POP患者 (POP组 )及 3例无SUI和POP的直肠癌患者 (对照组 ) ,术中行肛提肌活组织检查 (活检 )。常规组织学染色 ,镜下观察、测量肛提肌肌纤维直径 ,并进行分型。结果　SUI组和POP组患者肛提肌肌纤维密度减小 ,被丰富的纤维结缔组织充填、取代。含肌纤维的 4例SUI患者肛提肌肌纤维直径为 (2 4± 9) μm ,3例POP患者肛提肌肌纤维直径为 (2 4± 5 ) μm ,对照组肛提肌肌纤维直径为 (5 4± 11) μm。SUI组和POP组肛提肌肌纤维直径比较 ,差异无显著性 (P >0 0 5 ) ,但均较对照组肛提肌肌纤维直径缩短 (P <0 0 5 )。SUI、POP、对照组肛提肌肌纤维中Ⅰ型纤维 (慢纤维 )分别占 79 6 %、97 2 %和 77 2 % ,SUI、POP组Ⅱ型纤维 (快纤维 )比例均降低。对照组肛提肌肌纤维直径与年龄、绝经时间呈显著的负相关 (P =0 0 0 0 )。结论　SUI和POP患者肌肉的明显纤维化、退行性改变 ,快纤维减少 ,不利于在腹压增高时产生有力收缩。     

盆底功能障碍性疾病盆底解剖学静动态磁共振成像研究

目的:通过静动态磁共振成像(MRI)检查,比较女性盆底功能障碍性疾病(PFD)患者及正常女性盆底解剖结构改变,探讨盆底特定解剖学异常是否与PFD有关,为盆底重建手术提供客观依据。方法:选择2008年1月至2009年3月确诊为PFD患者46例为研究对象(PFD组),其中盆腔器官脱垂(POP)24例,压力性尿失禁(SUI)10例,POP合并SUI12例;同期选取正常女性14例为对照组。采用静动态MRI进行盆底扫描。比较两组髂尾肌、耻尾肌及耻直肌静动态面积、肛提肌裂孔静动态宽度、膀胱尿道后角、LH线及M线长度、肛提肌角等参数值的变化。结果:PFD组患者静态髂尾肌、耻尾肌、耻直肌的面积大于动态,肛提肌裂孔宽度在静态时小于动态(P<0.05)。而对照组以上参数值在静动态下无明显改变(P>0.05)。PFD组患者膀胱尿道后角、LH线、M线均大于对照组,肛提肌角小于对照组(P<0.05)。结论:MRI能清楚显示盆底解剖结构及功能,肛提肌的形态及功能异常与PFD有关。     

Concomitant trocar-guided transvaginal mesh surgery with a midurethral sling in treating advanced pelvic organ prolapse associated with stress or occult stress urinary incontinence

ObjectiveThe purpose of this study was to evaluate the efficacy and feasibility of concomitant trocar-guided transvaginal mesh (TVM) surgery with a midurethral sling (MUS) for treating women with advanced pelvic organ prolapse (POP) and stress urinary incontinence (SUI) or occult SUI (OSUI).Materials and methodsEighty-nine women with advanced POP and SUI or OSUI were retrospectively enrolled. The Total Prolift and Tension-free Vaginal Tape-Obturator Systems were used for trocar-guided TVM surgery and MUS. Patients received regular follow-up at 1 week, and 1 month, 3 months, 6 months, and 12 months postoperatively, and then annually thereafter. The endpoints were the success rate for POP, and perioperative and postoperative complications. Functional outcomes were the presence of voiding difficulty, persistent or de novo overactive bladder symptoms, postoperative SUI, and paresthesia.ResultsThe median follow-up period was 35 months (range, 12–50 months). Within the follow-up period, 84 patients (94.4%) were objectively cured, five patients (5.6%) had vaginal apical mesh exposure, 29 individuals (32.6%) had persistent or de novo overactive bladder symptoms, six individuals (22.5%) had de novo SUI (two were found by urodynamics), and nine individuals (10.1%) had voiding difficulties (two were found by urodynamics). In addition, the vaginal hysterectomy group had greater blood loss, longer operation times, and a higher mesh erosion rate compared to the uterine suspension group.ConclusionConcomitant trocar-guided TVM surgery and MUS with the use of total Prolift and Tension-free Vaginal Tape-Obturator offer good efficacy in treating women with advanced POP and SUI or OSUI. The vaginal hysterectomy group had more perioperative complications.     

Comparison of the clinical and quality-of-life outcomes after the inside-out TVT-O procedure with or without concomitant transvaginal gynaecological surgery

The study was undertaken to compare the clinical and quality-of-life (QoL) outcomes of the inside-out transobturator vaginal tape (TVT-O)-only procedures and TVT-O procedures with concomitant transvaginal gynaecological surgery for the treatment of stress urinary incontinence (SUI). A review of charts from January 2006 to March 2010 identified 305 patients with urodynamic stress incontinence for whom we performed the TVT-O. Of the initial 305 patients, 272 (89.2%) were re-examined for complications 1 month, 4 months, 1 year and 2-4 years postoperatively (122 TVT-O only; 150 TVT-O + other transvaginal gynaecological surgery). They were also evaluated with the Urogenital Distress Inventory Questionnaire (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7) 1-4 years after the procedure. The median follow-up was 37.3 months. The success rate was 89.3% in the TVT-O-only group vs 93.3% in the TVT-O with concomitant gynaecological surgery group (p =0.729). The QoL score was quite good for 91.8% of the TVT-O-only patients and for 96.7% of the TVT-O with concomitant gynaecologic surgery patients (p =0.405). In conclusion, gynaecological operations performed concomitantly with the TVT-O procedure do not affect the clinical and QoL outcomes of the TVT-O procedure.