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改良全盆底重建术治疗重度盆腔脏器膨出
作者姓名:Ren C  Zhu L  Lang JH  Shi HH
作者单位:中国医学科学院,北京协和医学院,北京协和医院妇产科,北京,100730
摘    要:目的评价改良全盆底重建术治疗盆腔脏器膨出的临床结局。方法对30例经盆腔器官脱垂评分(POP-Q)诊断为重度子宫脱垂(包括穹隆脱垂)的患者行改良全盆底重建术,并评价术后1年内各项客观和主观指标。结果30例患者平均手术时间(74.2±21.5)min,术中出血平均(103.3±40.1)ml;76.7%的患者次晨即可拔除尿管,且残余尿小于100ml;平均术后住院时间(4.2±1.8)d;中位随访时间6个月,以POP-Q评分为客观疗效评价指标,治愈率达93.3%;以脱垂生活质量量表为主观评价指标,主观满意度达96.7%。术后仅1例发生网片侵蚀,6.7%的患者出现新发急迫性尿失禁。发生率最高的并发症为性交痛,为66.7%,患者术前性生活质量平均(13.2±6.9)分]优于术后平均(15.7±3.7)分],但术前、后的盆腔器官脱垂-尿失禁性功能量表评分差异无显著性(P>0.05)。结论改良全盆底重建术是一种安全、有效、微创的治疗重度盆腔脏器脱垂的手术方式,但术后性交痛是一个需要注意的问题。

关 键 词:盆底重建  盆腔脏器膨出  子宫重度脱垂  临床结局
文章编号:1000-503X(2007)06-0760-05
收稿时间:2007-03-30
修稿时间:2007年3月30日

Modified total pelvic floor reconstruction for repair of severe pelvic organ prolapse
Ren C,Zhu L,Lang JH,Shi HH.Modified total pelvic floor reconstruction for repair of severe pelvic organ prolapse[J].Acta Academiae Medicinae Sinicae,2007,29(6):760-764.
Authors:Ren Chang  Zhu Lan  Lang Jing-He  Shi Hong-Hui
Institution:Department of Obstetrics and Gynecology, PUMC Hospital, CAMS and PUMC, Beijing 100730, China.
Abstract:OBJECTIVE: To evaluate the clinical outcome of a novel approach for pelvic floor reconstruction using synthetic mesh (modified total pelvic floor reconstruction) for treatment of pelvic organ prolapse. METHODS: Modified total pelvic floor reconstruction was performed in 30 patients with severe pelvic organ prolapse (including vault prolapse). The clinical outcome of each patient was assessed. RESULTS: The mean operation time was (74.2 +/- 21.5) minutes, and the mean blood loss was (103.3 +/- 40.1) ml. Among them, 23 patients (76.7%) were able to micturate spontaneously the next morning after surgery, with residual urine less than 100 ml. The mean post-operative hospital stay was (4.2 +/- 1.8) days. All patients were followed up for a medium of 6 months. Totally 93.3% and 96.7% of patients were objectively (according to Pelvic Organ Prolapse Quantitive Examination score) and subjectively (according to Prolapse Quality of Life) cured, respectively. During follow-up, only one patient was found to have asymptomatic erosion, and de novo urgent urinary incontinence was seen in 6.7% of patients. The most prominent complication was dyspareunia (66.7%). Although the post-operative sexual function was reported to be worse, no significant difference between patients' pre- and post-operative Pelvic Organ Prolapse/ Urinary Incontinence Sexual Function Questionnaire-12 scores was noted. CONCLUSION: Modified total pelvic floor reconstruction is a safe, effective, and micro-invasive approach for severe pelvic organ prolapse repair; however, dyspareunia remains a main concern.
Keywords:pelvic floor reconstruction  pelvic organ prolapse  severe uterine prolapse  clinical outcome
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