Prolift全盆底修补系统在老年女性全盆底重建术中的应用

目的通过对Prolift全盆底修补系统在老年女性盆腔器官脱垂治疗中的应用及近期疗效的评估,探讨治疗盆腔器官脱垂的手术方式。方法选取2009年1月至2010年12月间南京市妇幼保健院妇科收治的因盆腔器官脱垂行盆底修复重建手术的老年女性患者共43例。其中采用Prolift全盆底修补系统行全盆底重建手术24例（A组）,传统的阴道前后壁修补手术19例（B组）。比较2组患者的一般资料、围手术期和随访情况,并进行统计学分析。结果 2组患者的年龄、体质量、孕产次、阴道壁脱垂程度差异无显著性（P〉0.05）。2组患者的手术时间、术中出血量、尿管留置天数、术后残余尿和住院时间比较,差异无显著性（P〉0.05）。2组术后随访率均为100%。A、B组术后复发各为0和3例,A组复发率明显低于B组（P〈0.05）;A组发生性生活不适者3例,略高于B组的1例,但无显著性差异（P〉0.05）;A组补片侵蚀2例（8.33%）,2组均未发生直肠、输尿管等周围脏器及明显血管神经损伤。结论 Prolift用于阴道前后壁脱垂患者的全盆底重建手术,手术安全可行,近期疗效明显优于传统的阴道前后壁修补术。     

桥式缝合术治疗阴道后壁膨出临床观察

采用桥式缝合术治疗阴道后壁膨出26例。手术均获成功，未出现并发症，随访2～13个月无复发。认为桥式缝合术是治疗阴道膨出安全、有效的术式。     

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。     

阴道全封闭术治疗老年女性盆腔器官脱垂的疗效

目的分析老年女性盆腔器官脱垂(POP)患者实施阴道全封闭术的临床疗效及安全性。方法选取2012年1月至2018年1月在佛山市妇幼保健院妇科住院治疗、盆腔器官脱垂分期法(POP-Q)评定为Ⅲ~Ⅳ期、并接受阴道全封闭术治疗的78例老年POP患者。所有患者治疗后进行1年随访观察,记录术前和术后POP-Q分期情况。分析患者盆腔症状及患者满意度情况。采用盆底功能障碍量表(PFDI-20)[包括尿失禁困扰量表(UDI-6)、结-直肠肛门困扰量表(CRADI-8)、盆腔脏器脱垂量表(POPDI-6)]及盆底功能障碍影响量表(PFIQ-7)对患者术前和术后生活质量进行评价。采用χ2检验对手术前后患者的盆腔器官脱垂症状等进行比较;采用t检验对患者手术前后的生活质量评分结果进行比较。结果1例患者术后复发(≥Ⅱ期),总体疗效为98.71%(≤Ⅰ期)。POP患者外阴肿物脱出、盆腔坠胀感、尿频尿急症状、排尿困难、压力性尿失禁、排便困难等盆腔器官脱垂症状术后较术前明显减少,差异有统计学意义(P<0.05);患者术后主观满意度为100%。PFDI-20(UDI-6、CARDI-8、POPDI-6)和PFIQ-7量表评分术后较术前明显降低,差异有统计学意义(P<0.05)。结论对老年POP患者实施阴道全封闭术可显著降低患者的POP-Q分期及改善盆腔症状,术后患者满意度高,生活质量提高。     

改良盆底重建术治疗盆腔脏器脱垂疗效观察

目的观察改良盆底重建术治疗盆腔脏器脱垂的疗效。方法50例盆腔器官脱垂患者,随机分为对照组和观察组各25例。对照组采用传统盆底重建术,观察组行改良盆底重建术。结果两组患者手术顺利。观察组阴道前壁脱垂全部得到纠正;随访1a均未出现复发;未见手术并发症。对照组6例复发,2例发生尿潴留,2例阴道聚丙烯补片修补术后发生侵蚀。观察组保留尿管时间和平均住院天数均明显少于对照组（P均〈0．05）。结论改良盆底重建术治疗盆腔脏器脱垂安全有效。     

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。     

全盆底重建术治疗老年妇女子宫或阴道脱垂的临床研究

女性盆底功能障碍性疾病（pelvic floor dysfunction,PFD）是由于各种原因所致支持盆底组织的结缔组织或韧带损伤,进而盆腔脏器移位引发其他盆腔内器官的位置和功能异常的一类疾病。近年来基于吊床理论的盆底重建手术为这一类疾病的治疗带来了新的视角,已有研究显示术后复发率显著降低,但随之而来的新的手术并发症也备受关注。本研究旨在探讨全盆底重建术治疗老年妇女子宫或阴道脱垂的临床疗效。     

全盆底重建术与传统阴式手术治疗盆腔器官脱垂的疗效及安全性评价

目的 评价全盆底重建术与传统阴式手术治疗盆腔器官脱垂的疗效及安全性.方法 计算机检索PubMed、HighWire、EMbase、VIP、CNKI、万方数据库、中国生物医学文献数据库、西文生物医学期刊文献数据库,纳入盆底重建术与传统阴式手术治疗盆腔器官脱垂的随机对照试验（RCT）研究.对纳入的RCT研究进行质量评价,采用RevMan 5.1软件进行Meta分析.结果 纳入RCT研究10个（10篇文献）,共计706例受试者.与传统阴式手术治疗者相比,盆底重建术患者的手术时间短、术中出血量少、排气时间短、住院时间短（P均＜0.05）,且复发率低（P＜0.01）.结论 相对于传统阴式手术,全盆底重建术治疗盆底器官脱垂疗效好且安全.     

阴式子宫切除术及阴道前后壁修补术治疗中老年性子宫脱垂的疗效分析

目的探讨阴式子宫切除术及阴道前后壁修补术治疗老年性子宫脱垂的疗效。方法分析48例行阴式子宫切除术及阴道前后壁修补术的中老年患者的手术疗效及术后随访(2年)结果。结果 48例子宫脱垂及阴道脱垂中老年患者经阴道手术效果满意,术后无一例复发。结论阴式子宫切除及阴道前后壁修补术具有损伤少,恢复快,无腹部疤痕等优点,值得临床推广应用。     

中盆腔功能障碍手术治疗进展

女性盆底功能障碍性疾病是中老年女性常见病,50%经产妇可能会发生盆腔器官脱垂。中盆腔功能障碍,主要表现为子宫或阴道穹窿脱垂以及直肠子宫陷凹疝形成,治疗中盆腔功能障碍的常用手术有阴道骶骨固定术、McCall后穹隆成形及高位骶韧带悬吊、骶棘韧带固定术、经阴道后路悬吊带术、全盆底重建术等,该文对这些手术方式的适应证、手术方法、并发症及防治进行综述。     

新型阴道扩张器的研制及其临床应用

目的介绍一种新型阴道扩张器并探讨其临床应用效果。方法自行研制新型阴道扩张器。将534例行产后阴道缝合术患者随机分为观察组和对照组各267例,观察组术中应用新型阴道扩张器,对照组应用传统拉钩方法暴露术野。观察两组缝合时间、术中出血量及术后阴道血肿发生情况。结果观察组手术缝合时间明显短于对照组,P〈0．05;术中出血量明显少于对照组,P〈0．05;术后阴道血肿发生率显著低于对照组,P〈0．01。结论新型阴道扩张器可提高产后阴道缝合术的手术效果,值得推广。     

妇科盆腔阴式手术后并发下肢深静脉血栓40例诊治探讨

目的：探讨妇科盆腔阴式手术后并发下肢深静脉血栓（ LEDVT）的临床治疗效果。方法回顾性分析40例妇科盆腔阴式手术并发LEDVT患者的临床表现特点、诊断及治疗方法。结果妇科盆腔阴式手术后LEDVT的发生率为1％（40／4000）,采用复方丹参注射液、低分子肝素钙注射液及低分子右旋糖肝注射液,或者加用活血化瘀中药、路路通及阿司匹林等药物治疗后,40例LEDVT均治愈。随访3个月～2年,所有患者均无后遗症出现。结论对妇科盆腔阴式手术后的LEDVT患者,应做到早诊断、早治疗,可获得满意的疗效。     

Clinicopathological analysis of ovarian sertoli-leydig cell tumor with postmenopausal vaginal bleeding as the first symptom: A case report

Rational:Ovarian sertoli-leydig cell tumor (OSLCT) is extremely rare. We reported a OSLCT case in whom postmenopausal vaginal bleeding was the first symptom.Patient concerns:The patient came to our hospital due to postmenopausal vaginal bleeding.Diagnoses:Serum tumor markers and color Doppler ultrasound for her pelvic cavity were negative. The patient was finally diagnosed with left OSLCT by pathology. It was difficult to make a definite diagnosis before operation, the diagnosis of OSLCT required postoperative pathology in the patients.Interventions:the patient underwent laparoscopic hysterectomy+bilateral adnexectomy+lysis of pelvic adhesions.Outcomes:Postoperative laboratory examinations were normal. The patient was discharged from our hospital on the seventh day after operation and came to our hospital for follow-up check in April 2020. Physical and laboratory examinations were normal.Lessons:OSLCT can show different endocrine abnormalities, which are related to the various types of tumor tissues. Missed diagnosis and misdiagnosis are likely to occur in the patients who only have elevated serum testosterone. For the menopausal women with elevated serum testosterone, ovarian tumor shoule be highly suspected after excluding adrenal gland-related diseases.     

Abdominal colporectopexy with pelvic cul-de-sac closure

PURPOSE: Rectal prolapse and posthysterectomy vaginal vault prolapse often occur together and constitute a management problem. This article describes a combined colorectal and gynecologic approach to surgical management and reports the follow-up results of treatment. METHOD: Patients who presented with both rectal and gynecologic symptoms of prolapse subsequent to hysterectomy and were found on clinical examination to have overt and/or occult prolapse of both the rectum and the vaginal vault were considered suitable for a combined operative procedure. This consisted of an abdominal mesh rectopexy, abdominal closure of the pelvic cul-de-sac (enhanced by intravaginal endoscopic transillumination), and a colpopexy attaching forward extensions of the same mesh to the apex of the anatomically restored and reinforced vaginal vault. The operation was also accompanied by a colporrhaphy if prolapse of the lower one-third of the vagina was still evident on completion of the abdominal procedures. RESULTS: Eighty-nine patients underwent combined surgery. Sixty of these patients had a concurrent vaginal repair. The mean follow-up time was approximately five years. There were no perioperative deaths, and the morbidity rate was 9 percent. No injury occurred to the urinary tract, and no wound or pelvic infections were evident. There was no recurrence of either the rectal or vaginal vault prolapse. Improvement occurred in all major symptoms, especially in pelvic pain. CONCLUSIONS: The problem of coexisting rectal and posthysterectomy vaginal vault prolapse can be corrected by combined abdominal colporectopexy and closure of the pelvic cul-de-sac. For 89 patients this operation provided considerable relief of symptoms, with no evidence of recurrence of rectal or vaginal vault prolapse at follow-up.     

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.     

Evaluation of the distance from the anterior cervicovaginal junction to the anterior peritoneal reflection for anterior colpotomy during vaginal hysterectomy in Korean women

This study aimed to know the distance of the cervicovaginal junction (CVJ) to the anterior peritoneal reflection (APR) as measured in surgical specimens, and assess the distance between the CVJ and APR to ensure safe anterior colpotomy for vaginal hysterectomy among Korean women.Patients who underwent vaginal hysterectomy were included in the analysis. According to the presence of pelvic organ prolapse or menopausal status, the distance from the CVJ to the APR was assessed preoperatively through transvaginal ultrasonography (TV-US), as well as intraoperatively using surgical specimens. The intraclass correlation coefficient was used to determine the reliability between 2 measurements.In total, 171 patients were included. The median distance from the CVJ to the APR measured on TV-US was 19.8 (3.3–41.3) mm. Meanwhile, the median distance from the CVJ to the APR measured using the surgical specimen was 26.0 (12.0–55.0) mm. The intraclass correlation coefficient for the absolute agreement between 2 measurements was 0.353 (95% confidence interval: 0.002–0.570; P < .001), which is indicative of poor reliability. The median distance from the CVJ to the APR measured using the surgical specimen did not differ significantly between the 2 groups according to pelvic organ prolapse (26.0 [12.0–55.0] vs 27.5 [17.0–55.0] mm, P = .076] and menopausal status (27.0 [15.0–55.0] vs 26.0 [12.0–55.0] mm, P = .237).TV-US does not an accurately measure the dissection plane length from the CVJ to the APR during anterior colpotomy. During vaginal hysterectomy, the median distance from the CVJ to the APR measured using the surgical specimen was 26 (12.0–55.0) mm, which can help decrease surgical complications.     

Primary vaginal malignant melanoma: A rare case report of successful treatment with nivolumab

Rationale:Primary vaginal malignant melanoma is a sporadic and very aggressive tumor that is treated through surgery or radiotherapy combined with chemotherapy. Since most cases are diagnosed at an advanced stage, the operation range is extensive, the quality of life is poor, and the prognosis is gloomy.Patient concerns:A 58-year-old woman presented irregular water-like leukorrhea for 1 month after 6 years of menopause. Positron emission tomography-computed tomography revealed a 3.1 × 2.6 × 3.2 mass on the middle and lower part of the right vaginal wall. A gynecological examination revealed a 2 to 3 cm exophytic black mass in the lower-right part of the vaginal orifice. This mass was 2 cm from the urethral orifice. Furthermore, the mucosa of the anterior inferior vaginal wall had blackened and thickened, and there were some scattered black dots at the medial labia minora.Diagnosis:Due to the patient''s symptoms with radiographic findings, the postmenopausal woman was diagnosed with primary vaginal malignant melanoma.Interventions:Surgery was done to remove the mass. The patient also underwent inguinal lymph node dissection, received immunotherapy, and was treated with nivolumab.Outcomes:After a 6-month follow-up period, the patient underwent a routine gynecological examination with negative radiological results. Moreover, no local recurrence or distant metastases were found.Lessons:This patient showed a good response to immunotherapy. With this treatment method, the prognosis is better for advanced-stage women, especially those who cannot endure the surgery. Local lesion resection and inguinal lymph node dissection combined with immunotherapy are recommended. The case reported here may help treat similar clinical cases.     

GnRH analogue followed by surgery in treatment of vaginal leiomyoma-a case report

Rationale:Vaginal leiomyoma is a rare type of leiomyoma that occurs on the wall of vagina. Treatment for vaginal leiomyoma is varied and is based on the location and size of the leiomyoma.Patient concerns:In this case, a 24-year-old newly married Chinese woman complained of dyspareunia. The physical examination revealed a solid mass on the anterior wall of vagina. It almost filled up the whole vagina cavity.Diagnosis:Transvaginal ultrasound showed a tumor on the anterior wall of vagina. Pelvic computed tomography (CT) and magnetic resonance imaging (MRI) also confirmed the tumor on vaginal wall. Fine needle aspiration biopsy confirmed fibrous and smooth muscle tissue in the tumor, and immunohistochemical examination found the estrogen receptor (ER) and progesterone receptor (PR) were positive.Interventions:6 courses of gonadotropin-releasing hormone (GnRH) analogue were given before the patient underwent complete surgical resection through vagina.Outcome:No postoperative complications occurred, and the patient was discharged from the hospital 3 days after surgery. Follow-up after 3 months revealed negative symptoms of genitourinary system. No sign of recurrence was found.Conclusion:In this case, vaginal leiomyoma was diagnosed with help of imagological examinations like ultrasound, CT, and MRI, as well as pathological examination like fine needle aspiration biopsy. Preoperative GnRH analogue treatment can ensure smooth surgical procedure, and reduce blood loss during surgery.     

Anorectal complications of vaginal delivery

The incidence of anorectal complications following vaginal delivery was studied in 20,500 women. One thousand forty (5 percent) of all normal vaginal deliveries resulted in episiotomy with third- and fourth-degree extension or a fourth-degree perineal tear. Of these fourth-degree lacerations, 101 patients (10 percent) experienced wound disruption after primary repair. Sixty-seven patients (66 percent) experienced wound disruption that required surgical correction. Anorectal complications were anal ulcer, anorectal abscess, sphincteric disruption, and rectovaginal fistula. Surgical correction of these complications resulted in satisfactory outcome.     

Follow-up evaluation of the effect of vaginal delivery on the pelvic floor

PURPOSE: The aim of this study was to evaluate the effect of vaginal delivery on the pelvic floor by serial measurement of pudendal nerve terminal motor latency, perineal descent, and anal pressure before and after delivery. METHODS: Eighty pregnant females (40 primigravidae, 40 multigravidae) expecting vaginal delivery were prospectively evaluated. Measurements of pudendal nerve terminal motor latency, perineometry, and manometry were performed two to three months before delivery and two to three days, two months, and six months after delivery. RESULTS: Before delivery, pudendal nerve terminal motor latency showed no significant difference between primigravidae and multigravidae. Perineal plane at straining was lower and the descent was larger in multigravidae than primigravidae. Anal squeeze pressure was also lower in multigravidae than primigravidae. Two to three days after delivery, regardless of the group, pudendal nerve terminal motor latency was prolonged, perineal plane at straining became lower, the descent increased, and anal squeeze pressure decreased. Two months after delivery, pudendal nerve terminal motor latency recovered to the level before delivery. Perineal descent also recovered somewhat, but remained increased after six months had passed. In primiparae, perineal plane at straining remained lower after six months had passed. However, in multiparae the plane remained lower only for two months and recovered by six months postpartum. Anal squeeze pressure also showed a moderate recovery, but still remained significantly lower at six months postpartum. CONCLUSIONS: Pudendal nerve damage and functional impairment in the pelvic floor sphincter musculature occurs during vaginal delivery. Pudendal nerve terminal motor latency recovers after two months, whereas functional disturbance in the pelvic floor persists at least until six months.Poster presentation at The American Society of Colon and Rectal Surgeons' 100th Anniversary and Tripartite Meeting, Washington, D.C., May 1 to 6, 1999.