腹腔镜阴道骶前固定术19例报告

目的探讨腹腔镜阴道骶前固定术(laparoscopic sacrocolpopexy,LSC)治疗女性盆腔器官脱垂(pelvic organ prolapse,POP)的临床疗效和安全性。方法 2013年2~11月因妇科疾病行子宫切除术同时行LSC治疗POP 19例。切除子宫后、沿右侧结肠沟打开后腹膜,将已裁好网片平铺于腹膜后,将网片一端缝合在整个阴道残端,另一端固定于骶岬的前纵韧带上,使网片平整无张力,关闭后腹膜。结果手术时间(116.7±32.8)min,术中出血量(73.3±47.5)ml,住院时间(5.0±1.9)d。19例随访8~19个月,平均11个月,客观治愈率为100%,主观满意度100%。结论 LSC创伤小,能够恢复和保持阴道长度,术后并发症少,防止阴道残端脱垂疗效肯定。     

全盆底重建技术治疗盆腔器官脱垂的疗效研究

目的探讨全盆底重建技术治疗盆腔器官脱垂的疗效。方法将我院2014年6月~2016年6月年收治的50例盆腔器官脱垂患者,随机分为两组。A组患者采取阴式子宫切除联合阴道壁修补术,B组患者采取全盆底重建术。术后进行定期随访,比较两组患者手术时间、术中出血量、保留尿管时间、平均住院时间、阴道长度、治愈率、复发率以及性生活满意率、术后POP-Q分度等指标。结果两组患者手术时间、术中出血量比较无统计学差异(P0.05)。B组患者保留尿管时间以及平均住院时间均明显短于A组,B组者阴道长度明显长于A组,治愈率和性生活满意率明显高于A组,复发率则明显低于A组;术后POP-Q分度优于A组。上述比较两组患者差异明显,有统计学意义(P0.05)。结论盆底重建术用以治疗盆腔器官脱垂损伤相对较小,可以取得良好的疗效。     

Avaulta solo~(TM)骨盆底修复系统联合TVT-O治疗阴道前壁脱垂合并压力性尿失禁的临床研究

目的:观察Avaulta soloTM骨盆底修复系统联合经闭孔经阴道无张力尿道中段悬吊术(TVT-O)治疗盆腔器官脱垂(POP)合并压力性尿失禁(SUI)的临床效果。方法:2011年1月~2012年2月我院收治阴道前壁脱垂合并SUI患者28例,同期行Avaulta骨盆底修复和TVT-O。术后定期随访,以盆腔脏器定量分度法(POP-Q)作为客观疗效评价指标,以盆腔器官脱垂/尿失禁性功能问卷(PISQ-12),盆底功能障碍影响问卷简版(PFIQ-7),盆底困扰量表简表(PFDI-20)作为主观治愈指标。结果:28例患者手术均顺利完成,手术时间(116.1±23.6)min,估计手术出血量为(83.9±54.4)ml,术后平均住院时间为(6.6±3.1)d。客观治愈率92.9%。随访24~36个月,平均25.7个月,术后2年主观评价量表各项与术前比较,差异有统计学意义(P0.05)。2例(7.1%)手术失败患者中1例术后仍有明显压力性尿失禁,另1例术后1周左右出现阴道前壁脱垂。另外有1例(3.6%)复发SUI。结论:Avaulta骨盆底修复系统同期联合TVT-O治疗阴道前壁脱垂合并SUI短期疗效确切,简便微创。     

盆底重建术治疗盆腔器官脱垂38例临床分析

目的 探讨盆底重建术治疗重度盆腔器官脱垂(POP)的有效性和安全性. 方法 回顾性分析2008年6月至2011年6月本院收治的重度POP进行盆底重建术的38例患者的临床资料. 结果 平均手术时间106±33.02分钟,术中平均出血量为150±68ml,尿储留3例,术后平均住院时间为6.22±2.19天,无1例出现严重并发症,术后网片暴露2例,解剖治愈率100％,术后调查结果显示其生活质量与术前比较有显著提高(P＜0.05). 结论 全盆底重建术治疗重度盆腔器官脱垂手术安全,解剖率恢复率高.     

腹腔镜后路骶棘韧带悬吊术治疗盆腔器官脱垂

目的探讨腹腔镜后路骶棘韧带悬吊术(laparoscopic posterior approach sacrospinous ligament suspension,LPASLS)治疗盆腔器官脱垂(pelvic organ prolapse,POP)的安全性和可行性。方法回顾性分析2016年11月~2017年7月9例LPASLS治疗盆腔器官脱垂的临床资料。7例为POP-Q分度Ⅲ度,2例为网片悬吊术后并发症。主观治愈定义为术后患者无任何自觉症状;客观治愈定义为术后盆腔器官脱垂POP-Q分度为0度。结果腹腔镜后路骶棘韧带悬吊术均顺利完成,其中7例同时行全子宫切除,8例行阴道前壁修补,1例行阴道后壁修补,3例行会阴修补。手术时间90~140(117.8±20.0)min。术中出血30~100(54.9±24.2)ml。术中并发症3例,包括1例乙状结肠浆肌层损伤,1例膀胱浆肌层损伤,1例盆底血管损伤。术后5例骶尾部疼痛不适感,均在3~4天自行缓解。术后随访1~8(4.3±2.1)月,主观治愈率和客观治愈率均为100%(9/9)。结论对于盆腔器官脱垂,腹腔镜后路骶棘韧带悬吊术是安全、可行的。     

腹腔镜腹股沟韧带悬吊术与腹腔镜骶骨固定术治疗重度盆腔器官脱垂的疗效分析

目的:探讨腹腔镜腹股沟韧带悬吊术(LILS)与腹腔镜骶骨固定术(LSC)治疗重度盆底器官脱垂(POP)的临床疗效.方法:回顾分析2016年1月至2018年12月因重度POP行LILS的42例患者(LILS组)与行LSC的46例患者(LSC组)的临床资料,对比分析两组手术时间、术中出血量、术中与术后并发症及术前、术后1年...     

阴道封闭术对老年盆腔器官脱垂患者生活质量改善的效果观察

目的:了解阴道封闭术对老年盆腔器官脱垂(POP)患者相关症状和生活质量的影响.方法:在2005年10月-2010年2月期间,采用盆底困扰量表简表(PFDI-20)及生活质量问卷盆底影响问卷简表(PFIQ-7),对解放军总医院第一附属医院妇产科60例因POP-Q Ⅲ～Ⅳ期重度POP实施阴道封闭手术患者,分别于术前、术后2...     

改良全盆底重建手术治疗女性盆腔器官脱垂35例疗效观察

目的评价改良盆底重建术治疗盆腔脏器脱垂的临床效果。方法盆腔脏器脱垂定量(POP-Q)分度为Ⅲ～Ⅳ度35例患者行改良盆底重建术,观察手术时间、术中出血量、住院时间等围手术期指标,以POP-Q分度为客观疗效评价指标,以临床症状消失为主观治愈指标。术后定期随访,观察疗效。结果手术平均时间(55士20.2)min、术中平均出血(100±40.2)ml,术后住院平均(4.5±1.5)d,术后随访3～18个月、中位随访时间6个月,客观治愈率94%(33/35),主观有效率91%(32/35)。术后仅1例发生网片侵蚀,3例发生排尿困难,2例发生性交痛,2例发生急迫性尿失禁。结论改良盆底重建术是治疗盆腔脏器脱垂的有效术式,保留子宫同时加强盆底组织,手术简单、安全、微创、经济,远期疗效有待进一步观察。     

聚丙烯网片盆腔悬吊术治疗盆腔脏器脱垂79例

目的探讨聚丙烯网片盆腔悬吊术治疗女性盆腔脏器脱垂(pelvic organ prolapse,POP)的疗效。方法回顾性分析2003年12月～2008年12月我院应用国产穿刺锥行网片介入手术治疗79例POP的临床资料,评估该术式的治愈率、并发症、复发率和新盆腔症状。POP分级采用盆腔器官脱垂量化系统(POP-Q)评定,泌尿生殖道症状问询采用盆底功能障碍疾病相关问卷(PFDI-20)。结果术后1年POP治愈68例(86.1%),好转8例(10.1%)。术后3个月内POP复发1例(1.3%),再次手术随访2年末复发;术后1年POP复发3例(3.8%)。排尿障碍术后3个月内发生2例(2.5%),术后1年发生1例(1.3%)。网片腐蚀术后3个月内发生5例(6.3%),术后1年发生3例(3.8%)。术后1年出现性生活不适或疼痛4例(5.1%),术后出现膀胱过度活动症(overactive bladder,OAB)5例(6.3%),与网片相关的疼痛1例(1.3%)。结论聚丙烯网片POP腔悬吊术治疗盆疗效满意,复发率低,最多见的并发症是网片腐蚀,新出现的问题是OAB。     

网片添加的盆底重建手术治疗子宫切除术后阴道穹隆脱垂

盆腔器官脱垂（pelvic organ prolapse,POP）是指盆腔器官和邻近的阴道壁突人阴道或从阴道脱出,是老年女性的常见病,约有11．1％的妇女可能因脱垂或尿失禁接受手术治疗,其中29％需要第2次,14％需要第3次手术。传统手术治疗POP复发率为25％～52％,故对于女性盆腔器官脱垂性疾病的治疗,减少复发率等问题开始被重视。2008年9月～12月我科对6例曾行阴式或开腹全子宫切除术后阴道穹隆脱垂施行网片添加的盆底重建手术,现报道如下。     

The Current Status of Laparoscopic Sacrocolpopexy: A Review

Context

Pelvic organ prolapse (POP) is a common problem in women that causes morbidity and a decreased quality of life. Sacrocolpopexy can treat women with vaginal vault prolapse (VVP), multicompartmental POP, and/or a history of failed prolapse procedures. Abdominal sacrocolpopexy (ASC) is the gold standard for VVP and is superior to vaginal sacrocolpopexy, with fewer recurrent prolapses and less dyspareunia. Vaginal prolapse repairs, however, are often faster and offer patients a shorter recovery time. Laparoscopic sacrocolpopexy (LSC) aims to bridge this gap and to provide the outcomes of ASC with decreased morbidity.

Objective

This review evaluates the recent literature on LSC as a therapy for POP.

Evidence acquisition

A PubMed search of the available English literature on LSC was performed. The reference lists of selected articles were reviewed, and additional on-topic articles were included. Some 50 articles were screened, 22 articles were selected, and the reported outcomes from 11 series are presented in this review.

Evidence synthesis

Laparoscopic experience with POP has advanced tremendously, and LSC results from >1000 patients in 11 series support this. Conversion rates and operative times have decreased with increased experience. Mean operative time was 158 min (range: 96–286 min) with a 2.7% conversion rate (range: 0–11%) and a 1.6% early reoperation rate (range: 0–3.9%). With a mean follow-up of 24.6 mo (range: 11.4–66 mo), there was, on average, a 94.4% satisfaction rate, a 6.2% prolapse reoperation rate, and a 2.7% mesh erosion rate. Several centers have demonstrated that excellent outcomes with LSC are reproducible in terms of operative parameters, durable results, minimal complications, and high levels of patient satisfaction.

Conclusions

LSC upholds the outcomes of the gold standard ASC with minimal morbidity. Longer prospective and randomized trials are needed to confirm these results.     

腹腔镜骶骨阴道固定术治疗重度子宫脱垂

目的：探讨腹腔镜骶骨阴道固定术治疗重度子宫脱垂的临床疗效。方法2011年1月～2013年4月对22例POP-Q分期Ⅲ、Ⅳ期的重度子宫或阴道穹隆脱垂患者行腹腔镜下“Y”形聚丙烯网片骶骨阴道固定术,合并阴道前、后壁膨出者分别于膀胱阴道间隙和直肠阴道间隙增加植入网片的长度,合并中度以上压力性尿失禁（ stress urinary incontinence ,SUI）者同期行经闭孔无张力尿道中段吊带术（transobturator tension-free vaginal tape, TVT-O）,采用POP-Q分期法和盆底功能障碍性疾病症状问卷-20（PFDI-20）、盆底疾病生活质量影响问卷短表-7（PFIQ-7）、盆腔器官脱垂/尿失禁性生活质量问卷-12（PISQ-12）分别评价解剖和功能疗效。结果22例均成功完成手术,1例因合并重度SUI同期行TVT-O,术中未发生膀胱、输尿管、直肠他大血管损伤。手术时间（134．3±36．6）min,术中出血量（77．3±37．8）ml,术后2～3 d拔尿管均能自主排尿,无尿潴留。22例术后随访（17．5±8．2）月,无手术失败及术后复发,无网片侵蚀、暴露;POP-Q分期Aa、Ba、C、Ap、Bp各指示点解剖位置中位数由术前1．5、3．0、2．0、-2．3、-1．5 cm分别恢复为术后-3．0、-3．0、-8．0、-3．0、-3．0 cm。 PFIQ-7、PFDI-20评分中位数由术前66．7、66．2分恢复为术后12．0、14．6分,PISQ-12评分由术前（69．4±10.3）分提高到（86．9±10．0）分（t＝12．351,P＝0．000）;UDI-6术前后无改善（Z＝-0．337,P＝0．736）。术后新发SUI 3例,急迫性尿失禁1例。术前6例尿失禁,术后2例症状减轻,4例症状加重,其中1例术后8个月行 TVT-O,3例功能锻炼并观察。患者主观满意度为95．4％（21/22）。结论腹腔镜骶骨阴道固定术是治疗重度子宫或穹隆脱垂的一种安全、有效的方法,但有诱发或加重尿失禁的风险。     

腹壁自体筋膜盆底悬吊术与腹腔镜下子宫颈悬吊术治疗盆底器官脱垂的疗效观察

目的:探讨腹壁自体筋膜盆底悬吊术与腹腔镜下子宫颈悬吊术治疗盆底器官脱垂的临床应用价值及对生活质量的影响。方法:将60例盆底器官脱垂患者随机分为观察组与对照组,每组30例,观察组行腹壁自体筋膜盆底悬吊术,对照组行腹腔镜下子宫颈悬吊术,应用盆腔器官脱垂定量分度法评估手术效果。术后6个月采用盆底功能障碍问卷短表对患者生活质量进行调查,采用盆腔器官脱垂尿失禁性功能问卷对患者性生活质量进行调查。结果:观察组手术时间[(72.32±8.34)min]、术中出血量[(57.43±8.52)ml]、尿管留置时间[(3.23±0.54)d]、术后住院时间[(7.32±0.69)d]均多于对照组[(53.34±6.88)min、(45.65±7.43)ml、(2.39±0.87)d、(6.27±0.75)d],差异有统计学意义(P0.01),术后两组Aa、Ba、C、D、Ap、Bp等指示点位置术后均较术前明显上升,其中观察组上升水平明显高于对照组,更接近解剖学位置(P0.01),盆底功能障碍问卷、排便功能障碍问卷及泌尿功能障碍问卷评分观察组明显低于对照组,盆腔器官脱垂尿失禁性功能问卷中情感、生理、总分等观察组均高于对照组(P0.05)。结论:腹壁自体筋膜盆底悬吊术与腹腔镜下子宫颈悬吊术在治疗盆底器官脱垂中均具有良好的临床治疗效果,其中腹壁自体筋膜盆底悬吊术治疗盆底器官脱垂恢复盆底器官解剖更理想,对患者术后生活质量影响较小。     

A Review of the Current Status of Laparoscopic and Robot-assisted Sacrocolpopexy for Pelvic Organ Prolapse

Context

Abdominal sacrocolpopexy (ASC) represents the superior treatment for apical pelvic organ prolapse (POP) but is associated with increased length of stay, analgesic requirement, and cost compared with transvaginal procedures. Laparoscopic sacrocolpopexy (LSC) and robot-assisted sacrocolpopexy (RSC) may offer shorter postoperative recovery while maintaining equivalent rates of cure.

Objective

This review evaluates the literature on LSC and RSC for clinical outcomes and complications.

Evidence acquisition

A PubMed search of the available literature from 1966 to 2013 on LSC and RSC with a follow-up of at least 12 mo was performed. A total of 256 articles were screened, 69 articles selected, and outcomes from 26 presented. A review, not meta-analysis, was conducted due to the quality of the articles.

Evidence synthesis

LSC has become a mature technique with results from 11 patient series encompassing 1221 patients with a mean follow-up of 26 mo. Mean operative time was 124 min (range: 55–185) with a 3% (range: 0–11%) conversion rate. Objective cure was achieved in 91% of patients, with similar satisfaction rates (92%). Six patient series encompassing 363 patients treated with RSC with a mean follow-up of 28 mo have been reported. Mean operative time was 202 min (range: 161–288) with a 1% (range: 0–4%) conversion rate. Objective cure rate was 94%, with a 95% subjective success rate. Overall, early outcomes and complication rates for both LSC and RSC appeared comparable with open ASC.

Conclusions

LSC and RSC provide excellent short- to medium-term reconstructive outcomes for patients with POP. RSC is more expensive than LSC. Further studies are required to better understand the clinical performance of RSC versus LSC and confirm long-term efficacy.

Patient summary

Laparoscopic and robot-assisted sacrocolpopexy represent attractive minimally invasive alternatives to abdominal sacrocolpopexy. They may offer reduced patient morbidity but are associated with higher costs.     

双反牵引复位结合PFNA治疗股骨粗隆间骨折的初步临床应用

目的探讨双反牵引技术辅助闭合复位PFNA内固定治疗股骨粗隆间骨折的临床效果。 方法选取2015年5月至2017年5月在本院接受治疗的80例股骨粗隆间骨折患者为研究对象，其中失访者10例，根据复位方式的区别，将其分为双反牵引复位组与牵引床复位组。对比两组手术时间、术中出血量等各项指标间的差异。 结果70例患者术后获得随访，随访率87.5%，平均随访14个月。男性31例，女性39例，平均年龄（83.8±0.5）岁。双反牵引组患者手术时间、出血量及术中骨折复位时间、术中透视次数[（76±11）min，（80±90）ml，（12±3）min，（20±2）次]少于牵引床组[（85±13）min，（100±104）ml，（25±3）min，（25±3）次]，差异具有统计学意义（t=1.624，P=0.043；t=-1.773，P=0.037；t=1.362, P=0.041；t=-2.757，P=0.035），双反牵引复位组术后1、3个月患侧髋、膝功能评分明显优于牵引床复位组（P<0.05），术后6、12个月两组髋膝功能评分比较，差异无统计学意义（P>0.05）。 结论双反牵引复位股骨粗隆间骨折操作简便，复位质量高，对周围组织血运保护好、时间短、康复快，近期疗效优。     

电刺激联合盆底肌训练治疗女性压力性尿失禁合并特发性逼尿肌过度活动的疗效观察

目的 探讨电刺激联合全程指导盆底肌训练治疗女性压力性尿失禁(SUI)合并特发性逼尿肌过度活动(IDO)的疗效.方法选取经尿动力学检查证实为SUI合并IDO女性患者70例.平均年龄(40±7)岁.采用神经肌肉电刺激治疗仪电刺激,每次60 min,每周3次.联合盆底肌训练,每次30 min,每天2次,疗程12周.记录治疗前后患者排尿日记,填写国际尿失禁咨询委员会尿失禁问卷简表(ICI-Q-SF)和尿动力学测定,并随访3个月疗效.结果 50例(71%)完成全程治疗.其中尿失禁症状完全消失8例(16%),IDO消失10例(20%),漏尿点压测定无漏尿发生6例(12%).治疗后总排尿次数、总漏尿事件次数、ICI-Q-SF评分、最大逼尿肌不随意收缩压和持续时间分别为(28±5)次/72 h、(10±5)次/72 h、(10±3)、(18±8)cm H2O和(8±3)s,显著低于治疗前的(43±8)次/72 h、(20±6)次/72 h、(17±3),(27±9)cm H2O和(13±6)s(P<0.01);最大排尿量、正常尿意膀胱压测定容量、最大膀胱压测定容量、漏尿点压和最大尿道闭合压分别为(225±48)、(210±48)、(247±48)ml、(94±11)和(59±8)cm H2O,显著高于治疗前的(159±37)、(141±39)、(178±36)ml、(81±15)和(55±8)cm H2O,差异有统计学意义(P<0.01).治疗结束时和3个月后有效率为66%和60%,差异无统计学意义(P>0.05).结论 电刺激联合盆底肌训练是一种治疗女性SUI合并IDO的有效方法.     

Laparoscopic sacral hysteropexy versus laparoscopic sacrocolpopexy with hysterectomy for pelvic organ prolapse

Introduction and hypothesis

Treating pelvic organ prolapse (POP) with uterine conservation and sacral hysteropexy has uncertain subjective and objective outcomes. We sought to compare laparoscopic sacral hysteropexy with laparoscopic sacrocolpopexy/total laparoscopic hysterectomy (TLH with LSC).

Methods

Clinical data of 34 patients who underwent TLH with LSC and 65 patients who underwent laparoscopic sacral hysteropexy performed by the same group of surgeons between January 2008 and December 2013 were reviewed retrospectively. The primary outcome was subjective satisfaction rate based upon validated questionnaire (Patient Global Impression of Change [PGI-C]). Secondary outcomes were: anatomical cure, impact on quality of life based upon validated questionnaires (pelvic floor distress inventory-short form 20 [PFDI-20], Pelvic Floor Impact Questionnaire 7 [PFIQ-7], and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 [PISQ-12]), surgical complications, and cost.

Results

After a mean follow-up of 33 months, the subjective satisfaction rate was significantly higher in the TLH with LSC cohort (92.3 % vs 100 %; p?<?0.001). The POP-Q scores in both groups were significantly improved postoperatively. However, the anatomical cure in the two groups (72.3 % vs 88.2 %; p?=?0.07) did not differ significantly The postoperative PFIQ-7 and PFDI-20 scores were significantly better in the TLH with LSC cohort than in the laparoscopic sacral hysteropexy cohort (p?=?0.043 and p?=?0.035 respectively).

Conclusions

Relative to laparoscopic sacral hysteropexy, the TLH with LSC approach provides similar anatomical results, excellent patient satisfaction, and improved quality of life scores.

     

Twenty years of laparoscopic sacrocolpopexy: where are we now?

Introduction and hypothesis  

Laparoscopic sacrocolpopexy (LSC) was first described almost 20 years ago. This technique aims to provide the outcomes of the gold standard abdominal approach while offering the benefits of minimally invasive surgery. However, the widespread diffusion of LSC in the management of pelvic organ prolapse (POP) is hampered by its presumed length and technical difficulties due to the inherent need for laparoscopic suturing skills.     

Optimism in women undergoing abdominal sacrocolpopexy for pelvic organ prolapse

BACKGROUND: Although studies suggest that optimism can predict health outcomes, the relationship has not been tested in women with pelvic organ prolapse (POP). This study sought to explore the relationship between optimism, prolapse severity, and symptoms before operation; and examine whether optimism predicts postsurgical functional status, treatment satisfaction, and treatment success. STUDY DESIGN: Data from the randomized Colpopexy and Urinary Reduction Efforts (CARE) study, in which stress continent women undergoing sacrocolpopexy to repair stage II to IV POP completed a baseline assessment of optimism and validated symptom and quality-of-life measures at baseline and 24 months. Relationships between optimism and demographics, clinical status, and functional and quality-of-life outcomes were assessed. RESULTS: Of 322 Colpopexy and Urinary Reduction Efforts study participants, 305 (94.7%) completed 24-month followup interviews. At baseline, there were no notable differences in optimism with respect to POP stage or history of earlier operations for prolapse or urinary incontinence. At baseline, women with greater optimism reported markedly better physical and mental functioning (p 相似文献