Long-term survival following aggressive surgery and radiotherapy for pelvic fibromatosis

Desmoid tumors of the female pelvis are rare. The efficacy of the available treatment modalities in improving survival and decreasing recurrence remains controversial. A 32-year-old woman presented with an asymptomatic large ischeorectal mass. Computed tomography scan revealed a large tumor adherent to the pubic bone and impinging on the bladder neck and the rectum. Aggressive surgical removal of the mass including partial osteotomy of the pubic bone was followed by radiotherapy. The patient is still alive 6 years later with no evidence of disease. Aggressive surgical management followed by radiotherapy is an acceptable means of treatment of locally invasive desmoid tumor of the female pelvis.     

带蒂腹直肌肌瓣用于盆腔廓清术盆底重建的初步探讨

Objective?To explore the feasibility and short-term effectiveness of pelvic floor reconstruction by pedicle rectus abdominis muscular flap after pelvic exenteration. Methods?Eight patients with pelvic floor reconstruction by pedicle rectus abdominis muscular flap after pelvic exenteration between October 2019 and June 2021 were reviewed and analysed retrospectively. Results?The patients were from 39 to 68 years old(median age 57.5), 2 pelvic floor reconstructions with partial pedicle rectus abdominis muscular flap, 6 pelvic floor reconstructions with whole pedicle rectus abdominis muscular flap, the reconstruction time were 60 to 90 minutes. 1 case had ureteral fistula and underwent further surgical repair. 2 cases complained of increased vaginal discharge, they were all improved with anti infection therapy after 1 month and without any further surgical intervention. Abdominal incision infection occurred in 2 cases, and the wound healed after debridement. The patients were followed up 2 to 13 months (median 6.5 months), 1 case died of tumor recurrece 4 months after surgery, and 7 patients survived. There was no late complication, such as bowel obstruction, bowel perforation and fistulas. There was no early and late muscular flap related complications. Conclusion?The pedicled rectus abdominis muscular flap is a safe, effective, simple and rapid method for pelvic floor reconstruction after pelvic exenteration.     

女性盆底功能及盆底肌功能评估方法

目前,盆底康复已成为预防和治疗女性盆底功能障碍性疾病的主要方法之一。了解盆底功能评估的意义,并正确选择盆底功能评估方法,对制定个性化盆底功能康复方案、提高治疗效果起着重要作用,文章对盆底功能及其评估方法进行归纳总结。     

腹腔镜手术与单纯药物治疗盆腔炎的疗效比较

目的 比较腹腔镜手术与单纯药物治疗盆腔炎的疗效。方法 将1998年2月-2004年2月间123例盆腔炎患者分为单纯药物治疗组、腹腔镜治疗组和开腹治疗组。单纯药物组42例，腹腔镜组45例，开腹治疗组36例。治疗后随访12个月。结果手术治疗组治疗后盆腔炎性包块和盆腔痛发生率与单纯药物治疗组相比差异有显著意义（P〈0．005）。结论腹腔镜检查是诊断急性盆腔炎的较好方法。单纯药物治疗对已形成脓肿者效果不好。对无脓肿者有一定疗效，但复发率高。腹腔镜配合敏感抗菌药物是盆腔炎的最好治疗方法。     

Using botulinum toxin for pelvic indications in women

Background: Botulinum toxin (BoNT) is a potent neurotoxin. Its ability to cause muscle paralysis is increasingly being utilised for the management of a number of conditions of interest to the gynaecologist.
Aims: This review aims to give the reader an overview of the use of BoNT for conditions presenting a management challenge for the gynaecologist, such as chronic pelvic pain and idiopathic detrusor overactivity.
Methods: The literature was reviewed regarding the use, side-effects and complications of BoNT in the pelvis, focussing on chronic pelvic pain, provoked vestibulodynia, conditions involving the lower gastrointestinal tract and detrusor overactivity.
Results: In terms of pain caused by pelvic floor spasm, daily pelvic pain and dyspareunia are the symptoms most likely to be improved by BoNT. Limited data regarding use for provoked vestibulodynia indicate an improvement in pain scores. In the lower gastrointestinal tract, injection into puborectalis has been showed to objectively improve intravaginal pressures, though there are no randomised controlled trials (class I studies) validating its use in this setting. Class I studies demonstrate a role for BoNT in the management of idiopathic detrusor overactivity, though long-term follow-up data are lacking. Potential problems with BoNT injection include toxin reactions, urinary and faecal incontinence, urinary retention and secondary treatment failure due to antibody production.
Conclusions: A single class I study supports the use of BoNT for refractory pelvic floor spasm; however, further adequately powered class I studies for this indication and for provoked vestibulodynia are warranted.     

女性盆底解剖及盆腔器官脱垂诊断评估模式

掌握女性盆底解剖是了解盆腔器官脱垂发病机制的关键,诊断并评估相关盆底解剖缺损是制定个体化治疗方案的前提,文章简述女性盆底解剖结构,探讨盆腔器官脱垂的诊断评估模式及手术方式。     

补片在女性盆底重建手术的应用-18例临床分析

目的初步探讨补片(mesh)在女性盆腔脏器脱垂手术重建盆底功能中的应用情况。方法我院妇科2004年3月～2005年4月期间共有18名患者因盆腔器官脱垂应用补片(mesh)进行盆底修补和重建。平均年龄68.6岁(48～78岁)。阴道前壁膨出17例,子宫脱垂15例,阴道后壁膨出12例。18例患者中14例行经阴式子宫切除术,1例行开腹全子宫切除术,1例保留子宫,2例已行子宫切除手术。同时行阴道前后壁修补术17例,单行阴道后壁修补术1例。单独置入阴道前壁补片11例,同时置入阴道前壁和后壁补片6例,单独置入阴道后壁补片1例。2例术中同时行阴道穹隆骶棘韧带悬吊术,4例术中行后路吊带阴道穹隆骶骨固定术。结果18例患者总手术时间平均为116.2min(85～150min),其中放置补片的时间平均15min。术中出血平均176ml(100～300ml)。术后恢复良好,术后住院时间5.4d(5～9d)。平均随访13.1个月(6～19个月),发现4例补片侵蚀阴道黏膜,发生率为22.2%,其中1例为前壁补片,此补片较大,为梯形补片,大小为5cm×12cm;3例为后壁补片。无补片感染发生。3例(16.7%)患者出现脏器膨出复发,1例阴道前壁膨出复发Ⅲ期,1例阴道前壁膨出复发Ⅰ期,1例阴道后壁膨出复发Ⅰ期。结论补片在女性盆底重建手术中的应用,方法简单,操作容易,不延长手术时间,患者耐受性好,但补片放置方法有待进一步探讨。     

经阴网片全盆重建术治疗重度盆腔器官脱垂中长期临床疗效评价

目的 探讨经阴网片全盆重建手术治疗盆腔器官脱垂的疗效及并发症,评估该手术的有效性和安全性。方法 回顾性分析2007年1月至2014年6月在广州医科大学附属第一医院因盆腔器官脱垂行经阴网片全盆重建术110例患者的临床资料,比较手术前后盆腔器官脱垂定量分期法(POP-Q)各指示点位置,评价总体客观治愈率及复发率。采用盆底功能障碍性疾病症状问卷简表(PFDI-20)等相关问卷评分评价主观治愈率以及术后尿失禁相关症状改善情况。结果 110例患者中失访12例（12/110, 10.91%）,其中1例因心血管疾病术后1年余死亡,随访98例（98/110, 89.09%）。随访时间6～90个月,中位随访时间：48个月。110例患者年龄(65.30±8.00)岁;绝经时间(14.01±9.08)年;采用POP-Q分期评价,术后15例（15/98,15.31%）出现复发,其中11例POP-Q分期Ⅱ期,无主观症状不需再次手术,4例阴道顶端复发（POP-Q Ⅲ期）,需再次手术治疗。术后主观治愈率95.92%(94/98）,客观治愈率84.69%(83/98）;网片挛缩4例（4/98, 4.08%）,网片外露11例（11/98,11.22%）。术后PFDI-20评分与术前比较,差异有统计学意义(P<0.05);术后性生活13例,其中性生活质量5例满意,6例患者较术前差,2例配偶出现性交疼痛;患者总体术后满意度评分满意率95.91%(94/98)。结论 经阴网片全盆重建术用于治疗重度盆腔器官脱垂主、客观治愈率高,不仅能达到较好的解剖学复位,对患者的盆腔器官脱垂相关症状有明显改善,术后满意度高且长期疗效稳定,但对性生活质量无明显改善。     

Closed suction drainage versus no drainage following pelvic lymphadenectomy for gynecological malignancies

Abstract. Bafna UD, Umadevi K, Savitha M. Closed suction drainage versus no drainage following pelvic lymphadenectomy for gynecological malignancies.
The present study was undertaken in the Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bangalore between October 1998 and July 1999. One hundred and forty three consecutive patients with various gynecological malignancies undergoing pelvic ± aorto-caval lymphadenectomy as part of definitive surgical procedures, were analyzed. Sixty nine patients had closed suction retroperitoneal pelvic drainage (Group A) and 74 patients had no suction drainage and no pelvic reperitonealization (Group B). The mean postoperative hospitalization was 10 days in both groups. Six patients in Group A and four patients in Group B developed paralytic ileus which responded to conservative line of management. Five patients in Group A and two patients in Group B developed lymphocysts ( P > 0.05). The present study demonstrates that closed suction retroperitoneal pelvic drainage following pelvic + aorto-caval lymphadenectomy confers no advantage over no drainage & no pelvic reperitonealization. The partial closure of pelvic peritoneum with no drainage was associated with increased lymphocyst formation (7/25 cases, 28%) during the period immediately before this modified study was undertaken.     

初产妇产后6周盆底电生理指标及盆腔器官脱垂分度状况全国多中心横断面研究

目的 获得中国初产妇产后早期盆底电生理指标及盆腔器官脱垂分度情况及危险因素分析。方法 自2011年10月在广西、广东、河北、河南、山西5省开展多中心横断面研究,在产后6周对产妇基本情况、产科情况及盆底电生理指标和盆腔器官脱垂分度（POP-Q）数据进行采集和统计学分析。结果 共入组1327例初产妇,产后6周的盆底电生理指标显示,Ⅰ类肌肌力3级以上的占47.5%,Ⅱ类肌肌力3级以上的占43.6%,盆底动态压力为（61.8±29.2）cmH2O。A3反射正常率为66.7%。分娩时会阴裂伤（OR=1.48;95% CI 1.11～1.97)和工作体位以站位为主（OR=1.57;95% CI 1.06～2.33)是发生Ⅰ类肌早期肌力下降的危险因素。盆底障碍性疾病家族史是Ⅰ类肌和Ⅱ类肌疲劳度异常的危险因素。盆腔器官脱垂分度中,第二产程延长是后壁Ap点（OR=10.02, 95% CI 1.88～53.49）和Bp点 (OR=5.57, 95% CI 1.19～26.01)下移的危险因素,会阴裂伤是中盆腔C点( OR=1.54, 95% CI 1.14～2.09)和D点(OR=2.61, 95% CI 1.51～4.53)下移的危险因素。结论 约半数初产妇产后早期盆底电生理指标处于受损状态,会阴裂伤和家族遗传史是其危险因素。第二产程延长和会阴裂伤是产后早期POP-Q分度位点下移的危险因素。     

全盆底重建术保留与切除子宫68例临床分析

目的评估保留与切除子宫的全盆底重建术在治疗盆底功能障碍性疾病的有效性和安全性。方法对2008年3月至2009年1月中国医科大学附属盛京医院68例有不同缺陷的女性盆腔器官脱垂患者分别进行保留子宫的全盆底重建术(35例,保留子宫组)及切除子宫的全盆底重建术(33例,切除子宫组)。对合并有压力性尿失禁的患者同时进行经闭孔尿道中段无张力悬吊术(TVT-O术)。根据国际尿控协会制定的盆腔器官脱垂定量POP-Q分度法客观评价手术效果。结果保留子宫组手术时间平均为50min,出血量平均为100mL。切除子宫组手术时间平均为110min,出血量平均为200mL。术后随访(8~18)个月,保留子宫组患者盆底结构基本正常,压力性尿失禁全部治愈,相关症状消失或明显改善,术后无感染发生。切除子宫组症状全部得到纠正,术后有2例感染发生,术后随访患者的盆底结构基本正常,相关症状消失或明显改善。术后3个月POP-Q评分两组较前均明显好转。结论保留子宫的全盆底重建术在保留子宫的同时能完成全盆底结构和功能的全部或部分重建,与切除子宫的全盆底重建术相比手术时间短,恢复快。近期疗效明确,远期疗效仍需观察。     

盆底重建术150例临床分析

目的探讨利用网片进行盆底重建术治疗女性盆腔器官脱垂并发症的临床特点、诊断、治疗及其预后。方法 2007年1月至2010年7月对南京军区福州总医院妇产科利用网片盆底重建术治疗中重度盆腔器官脱垂患者150例的临床资料进行总结,分析术中、术后并发症及其处理。结果 2例发生术中损伤膀胱,1例损伤直肠,无神经、血管、血肿等其他并发症。术后近期并发症:排尿困难3例(2.00%),深部血肿3例(2.00%),肛门坠胀及不适感5例(3.33%)。远期并发症:排便困难2例(1.33%),性交不适感2例(1.33%),网片侵蚀及膨出12例(8.0%)。术中、术后并发症的发生与患者绝经、产次、内科合并症、脱垂程度以及术中是否行阴式全子宫切除术、术中出血量无关。术后网片侵蚀及膨出发生于阴道前壁1例,后壁11例;症状以阴道异常流液、疼痛、异物感为主。排尿困难经网片松解治愈2例,需长期自我导尿1例;其余并发症经相应对症处理后自我缓解或自行缓解。结论利用网片进行盆底修复,现已成为盆腔器官脱垂治疗的趋势。     

Conservative management of pelvic organ prolapse

Pelvic organ prolapse is a common condition with 1 in 10 women undergoing surgery during their lifetime. In the community 8% of women complain of the symptom of a vaginal bulge which is the symptom that most closely correlates with the finding of a prolapse on examination. Pelvic organ prolapse can impair urinary, bowel and sexual function. The NICE National Guideline Urinary Incontinence and Pelvic Organ prolapse in Women: Management makes recommendations on the assessment and treatment of pelvic organ prolapse. The most important part of prolapse management is obtaining a comprehensive pelvic floor history and understanding the woman's treatment goals and expectations. A standardised examination aids further decision making. Conservative treatment options include observation, lifestyle advice, pelvic floor muscle training and use of a pessary. Treatment choice is guided by patient preference.     

Pelvic insufficiency fracture after pelvic irradiation in uterine cervix cancer

OBJECTIVES: Pelvic insufficiency fractures (IF) are well known but uncommon and are frequently misinterpreted sequelae. The clinical features were investigated. METHODS: Four hundred sixty-three patients, who were treated between 1994 and 2000 for uterine cervix cancer, were clinically examined. All patients had been treated with 10 or 15 MV photons, with 50.4-55.8 Gy in 28 fractions with adjuvant intent (n = 235) in addition to high-dose-rate brachytherapy 24 Gy in 6 fractions for curative treatment (n = 228). The median follow-up was 38 months. RESULTS: Eight patients (8/463, 1.7%) developed pelvic IF 7-19 months (median, 12 months) after the treatment. Among these, seven patients (7/228, 3.1%) were treated with curative intent and one (1/235, 0.4%) was treated with adjuvant intent. All patients were postmenopausal and complained of moderate to severe pelvic pain, which resolved after 1-11 months with conservative therapy in all patients. Two of these patients also had radiation proctitis. CONCLUSION: In women who present with pelvic pain after radiotherapy for cervical cancer, bony destruction and fractures may be indicative of a late radiation effect rather than osseous metastasis. IF are more common in the curative treatment group than in the postoperative adjuvant group.     

Chronic pelvic pain: a rare complication following a large-loop excision of the transformation zone

This is the unique report of a patient with deep-seated, left-sided pelvic pain following a large-loop excision of the transformation zone (LLETZ) for cervical intraepithelial neoplasia III. She transpired to have a definite diagnosis of pelvic varicosities which were only on the left side. Our surmise was that the varicosities had risen on the back of an arteriovenous malformation following her LLETZ performed by a colleague. The first attempted treatment was radiologic embolization. When this failed, she had a formal surgical procedure, and the left unilateral varicosities were ligated. Her pain ceased entirely thereafter, and she remained pain free at her 1-year review.     

Prolift盆底重建术治疗盆腔器官脱垂的疗效评价

目的评价应用Prolift盆底重建术治疗盆腔器官脱垂的临床效果。方法选择2007年10月至2009年10月江西省妇幼保健院妇科20例盆腔器官脱垂患者行Prolift盆底重建术,术后定期随访,以POP-Q分期作为客观疗效评价指标,以盆腔器官脱垂生活质量问卷（P-QOL）量表作为主观治愈指标。结果 20例患者的平均手术时间（78.6±30.2）min,平均术中出血量（155±65）ml,平均术后住院时间（4.3±1.8）d,术后2年客观治愈率95%。术后3个月、1年及2年P-QOL量表评分与术前比较,差异均有统计学意义（P〈0.05）。结论 Prolift盆底重建手术操作安全、微创,并发症少,术后生活质量明显改善,近中期疗效满意,值得临床推广。     

Conservative management of pelvic organ prolapse

Pelvic organ prolapse is a common condition with one in 10 women undergoing surgery during their lifetime. In the community 8% of women complain of the symptom of a vaginal bulge which is the symptom that most closely correlates with the finding of a prolapse on examination. Pelvic organ prolapse can impair urinary, bowel and sexual function. The most important part of prolapse management is obtaining a comprehensive pelvic floor history and understanding the woman's treatment goals and expectations. A standardised examination aids further decision making. Conservative treatment options include observation, lifestyle advice, pelvic floor muscle training and use of a pessary. Treatment choice is guided by patient preference.     

中国女性盆底肌肉锻炼的状况与未来

<正>盆底功能障碍性疾病是盆底支持组织缺陷和损伤性疾病。我国尿失禁流行病学调查的结果显示:妊娠分娩是盆底发生损伤及缺陷的第一位独立危险因素~([1])。以提肛肌为主的盆底支持结构因妊娠分娩而受到激素影响和过度牵拉,这些异常的作用可以对上述结构发生形态和功能上的改变引发盆底功能障碍性疾病。产后这一特定时期的特殊改变决定了在产后开展盆底肌肉锻炼的重要