手术治疗老年妇女盆腔脏器脱垂60例

盆腔脏器脱垂是老年妇女常见疾病,子宫从阴道及阴道前后壁膨出,造成局部黏膜溃疡,甚至引起排尿困难,严重影响患者的生活质量〔1〕。老年妇女盆腔脏器脱垂的手术治疗方式有多种,临床上最常用的为经阴子宫全切加阴道前后壁修补术,创伤大,并发症多〔2〕。而子宫颈部分切除加部分阴道封闭     

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。     

柳州地区女性盆腔脏器脱垂与压力性尿失禁之间的关系

目的研究柳州地区成年女性盆腔脏器脱垂(POP)与压力性尿失禁(SUI)之间的关系。方法采取整群抽样的方法选择在柳州市和下辖7个县的妇幼保健院就诊或住院的1 807例20周岁以上女性为研究对象,对其进行问卷调查以及妇科检查(POP-Q分期法),分析POP与SUI之间的关系。结果 1 807人中阴道前壁膨出者为1 424人,子宫脱垂者为1 144人,阴道后壁膨出者281人,POP患者中SUI患病率为51.3%,其中SUI在阴道前壁膨出、子宫脱垂和阴道后壁膨出的患者中患病率分别为18.2%、18.5%和22.1%。SUI患病率在四种阴道前壁膨出程度间差异有统计学意义(P0.01),且患病率随阴道前壁膨出程度增加而升高(P0.01)。不同子宫脱垂程度间SUI患病率差异有统计学意义(P0.01),且患病率随子宫脱垂程度增加而升高(P0.01)。但各组阴道后壁膨出间SUI患病率差异无统计学意义(P0.05)。结论阴道后壁膨出、阴道前壁膨出和子宫脱垂的病情越严重,并发SUI的危险性越大。     

部分阴道闭合术治疗高龄妇女严重盆腔脏器脱垂临床观察

目的观察部分阴道闭合术治疗高龄妇女严重盆腔脏器脱垂（POP）的疗效。方法老年POP患者28例,POP-Q分度为Ⅱ~Ⅳ度,均采用部分阴道闭合术治疗。结果本组手术顺利,未发生副损伤及并发症。术后尿失禁症状改善12例,排尿困难症状好转8例。术后6个月28例POP均无复发,术后12个月获得随访25例,3例因内科疾病死亡,余22例POP无复发,主观感觉满意。结论部分阴道闭合术治疗高龄妇女严重POP操作简单、安全、疗效较好,复发率低。     

四维超声诊断老年盆腔脏器脱垂及手术效果评估

目的探讨盆底四维超声对盆腔脏器脱垂(POP)的诊断价值以及对盆底手术后效果的评估。方法测量90例POP患者术前和术后及100例阴性对照组盆底结构二维、三维及四维超声数据指标,评估术前及术后的膀胱最低点、子宫宫颈前后唇、直肠壶腹部与耻骨联合后下缘的距离,肛提肌裂孔面积,并观察两组肛提肌形态结构。结果盆底手术前,Valsalva动作下POP组膀胱颈移动度较对照组增大(P<0.05);子宫宫颈前后唇距离耻骨联合后下缘水平线距离小于15 mm、膀胱最低点及直肠壶腹部位于耻骨联合后下缘水平线以下;术后,Valsalva动作下POP组膀胱颈移动度较术前减小(P<0.05);阴道残端位于耻骨联合后下缘水平线以上且距离大于15 mm、膀胱最低点及直肠壶腹部均位于耻骨联合后下缘水平线以上。结论盆底四维超声能很好地评估老年女性盆底结构,是有效诊断POP的辅助手段。同时,盆底四维超声还可以用来对盆底手术后效果的评估提供有效的依据,预防术后POP的复发。     

硅胶子宫托与盆底重建术治疗老年女性盆腔脏器脱垂远期疗效的比较

目的探讨硅胶子宫托与盆底重建术对老年女性盆腔脏器脱垂患者的治疗效果。方法回顾性分析126例老年女性盆腔脏器脱垂患者的临床资料,依据临床制定治疗方案的不同进行分组,分别为A组(硅胶子宫托,63例)与B组(盆底重建术,63例),比较两组盆底功能、治疗满意情况及并发症发生情况。结果治疗前与治疗后6个月,两组盆底障碍影响简易问卷(PFIQ-7)及盆底功能障碍问卷(PFDI-20)评分对比,差异无统计学意义(P>0.05);治疗后24个月,B组PFIQ-7与PFDI-20评分均明显低于A组,差异有统计学意义(P<0.05);治疗后6个月,两组治疗满意程度与总满意度对比,差异无统计学意义(P>0.05);治疗后24个月,B组满意程度与总满意度均明显高于A组,差异有统计学意义(P<0.05);A组并发症发生率为7.94%,B组为4.76%,两组差异无统计学意义(P>0.05)。结论老年女性盆腔脏器脱垂患者采用硅胶子宫托与盆底重建术治疗,均可获取良好的近期效果,且安全性较高,但后者远期盆底功能改善效果更为理想。     

单孔腹腔镜手术在妇科盆腔脏器脱垂疾病中的应用

盆腔脏器脱垂疾病是中老年女性的常见病,手术治疗是中重度盆腔脱垂的主要治疗方式。随着微创理念的发展,单孔腹腔镜手术已应用于女性盆腔脏器脱垂疾病。目前应用于盆腔脏器脱垂疾病的单孔腹腔镜手术方式有经脐单孔腹腔镜手术和机器人辅助单孔腹腔镜手术。该文对单孔腹腔镜手术在妇科盆腔脏器脱垂疾病中的应用现状进行综述。     

应用不可吸收网片盆底重建术治疗Ⅲ~Ⅳ度盆腔器官脱垂的疗效

目的探讨不可吸收网片应用于盆底重建术(TPMR)的可行性及有效性。方法网片组300例盆腔器官脱垂(POP)患者,在阴道前壁或后壁置入不可吸收的由聚丙烯材料制成的网片,根据国际尿控协会制定的盆腔器官脱垂定量(POP-Q)分度法,评价手术效果。疗效评定以术后无阴道壁脱垂为治愈,随访1⁷2个月。结果网片组300例手术顺利。手术平均时间为6072个月。结果网片组300例手术顺利。手术平均时间为60⁹0 min,术中出血平均为100 ml。患者术后恢复良好,住院时间平均7 d。术后随访390 min,术中出血平均为100 ml。患者术后恢复良好,住院时间平均7 d。术后随访3⁷2个月。PFIQ-7评分显示,患者膀胱或排尿症状、直肠或排便症状、阴道或盆腔症状3方面在术后372个月。PFIQ-7评分显示,患者膀胱或排尿症状、直肠或排便症状、阴道或盆腔症状3方面在术后3⁷2个月内均显著改善(P<0.05)。根据POP-Q评分标准,网片组术后6年内各指示点较术前明显复位,均无阴道壁膨出,30例网片暴露侵蚀阴道黏膜,3例术后排尿困难,3例膀胱损伤,1例直肠损伤。结论网片在子宫脱垂、阴道前后壁脱垂、膀胱膨出、直肠膨出、穹窿膨出修补手术中应用,操作简单,手术复发率低,网片暴露、侵蚀的并发症仍有待解决。     

不同分娩方式对盆底组织的影响

目的探讨不同分娩方式对盆底组织的影响。方法健康初产妇53例,其中阴道分娩32例（A组）,选择性剖宫产21例（B组）,分别于妊娠晚期和产后3、6个月用盆腔器官脱垂（POP）量化分期（POP-Q）分度法评测其POP程度。≥I度者为患病者。结果A组妊娠晚期及产后3、6个月时POP患病率分别为34．38％、68．75％、62．50％,与妊娠晚期比较,产后3、6个月患病率增加（P〈0．05）,以产后3个月时POP患病率最高（P〈0．05）。B组妊娠晚期及产后3、6个月时POP患病率分别为33．33%、38．10％、28．57％,与妊娠晚期比较,患病率增加不显著（P〉0．05）。B组产后3、6个月时的POP患病率均低于A组（P〈0．05）。结论自然分娩与剖宫产对产后盆底组织均有影响,选择性剖宫产可以降低产后早期POP患病率。     

Effects of Pelvic Organ Prolapse on the Bladder

Purpose of Review

To assess how pelvic organ prolapse (POP) and treatment affect bladder function.

Recent Findings

There is significant overlap between POP and bladder symptoms, including urinary incontinence and overactive bladder. POP may result in bladder outlet obstruction (BOO) secondary to urethral kinking, which may result in overactive bladder (OAB), dysfunctional voiding, and occult or de novo stress urinary incontinence (SUI). Improvements in obstructive symptoms and dysfunctional voiding after POP surgery suggest that pelvic floor reconstruction restores pelvic floor anatomic structure and function. Furthermore, correction of anatomic structure also seems to improve OAB symptoms, although a direct causative link has yet to be established.

Summary

Pelvic floor syndromes should be interpreted as a whole. POP, OAB, urinary incontinence, BOO, and dysfunctional voiding are all part of pelvic floor syndromes, coexisting and interacting to manifest different symptoms before and after POP treatment.

     

不同分娩方式对产后妇女盆底功能影响的临床分析

目的通过盆底功能评估了解产后妇女盆底功能障碍状况,分析比较剖宫产与阴道产两种分娩方式对产后盆底功能的影响,为盆底功能障碍性疾病(PFD)的防治提供理论依据。方法选取2014-01~2014-06间在该院分娩并于产后6~8周来产后门诊复查的800例产妇,根据分娩方式的不同分为剖宫产组288例和阴道产组512例做盆底功能常规评估,对其评估所获得的指标进行回顾性分析比较。结果手法检查辅以盆底肌评估筛查800例患者中,剖宫产组Ⅰ类肌纤维受损185例,Ⅱ类肌纤维受损168例;阴道产组Ⅰ类肌纤维受损504例,Ⅱ类肌纤维受损502例,两组比较差异有统计学意义(P0.01);阴道产组肌力收缩失调、肛提肌损伤、疲劳度异常、阴道动态压力值80 cm H2O均高于剖宫产组(P0.01)。结论相对于阴道分娩,剖宫产可在一定程度上降低对产妇盆底功能的影响,但盆底功能可通过进行产后康复锻炼来促进恢复,因此不应以此为依据进行分娩方式的选择。     

慢性便秘与女性盆腔器官脱垂的关系

背景:盆腔器官脱垂是妇科常见疾病,其病理生理机制尚未明确.目前观点认为慢性便秘很可能是女性盆腔器官脱垂的促发因素之一.目的:回顾性分析女性盆腔器官脱垂患者的慢性便秘患病情况,初步探讨两种疾病之间的关系.方法:收集2005年1月1日～12月31日1年间北京协和医院妇产科诊断为盆腔器官脱垂的住院患者的病史资料,由经统一培训的调查员对其进行电话问卷调查.慢性便秘的诊断参照罗马Ⅱ标准.结果:201例人选患者中.122例接受了电话问卷调查,应答率为60.7%.其中符合慢性便秘罗马Ⅱ标准者35例,患病率为28.7%,病程2～43年.轻度与中重度盆腔器官脱垂患者合并慢性便秘的比例差异无统计学意义(26.7%对29.3%,P＞0.05).结论:本研究中女性盆腔器官脱垂患者的慢性便秘患病率(28.7%)明显高于普通成年女性人群(4.28%～9.68%),慢性便秘与女性盆腔器官脱垂的关系尚有待进一步研究.     

Application of Tissue Engineering to Pelvic Organ Prolapse and Stress Urinary Incontinence

Synthetic or biological materials can be used for the surgical repair of pelvic organ prolapse (POP) or stress urinary incontinence (SUI). While non‐degradable synthetic mesh has a low failure rate, it is prone to complications such as infection and erosion, particularly in the urological/gynecological setting when subject to chronic influences of gravity and intermittent, repetitive strain. Biological materials have lower complication rates, although allografts and xenografts have a high risk of failure and the theoretical risk of infection. Autografts are used successfully for the treatment of SUI and are not associated with erosion; however, can lead to morbidity at the donor site. Tissue engineering has thus become the focus of interest in recent years as researchers seek an ideal tissue remodeling material for urogynecological repair. Herein, we review the directions of current and future research in this exciting field. Electrospun poly‐L‐lactic acid (PLA) and porcine small intestine submucosa (SIS) are two promising scaffold material candidates. Adipose‐derived stem cells (ADSCs) appear to be a suitable cell type for scaffold seeding, and cells grown on scaffolds when subjected to repetitive biaxial strain show more appropriate biomechanical properties for clinical implantation. After implantation, an appropriate level of acute inflammation is important to precipitate moderate fibrosis and encourage tissue strength. New research directions include the use of bioactive materials containing compounds that may help facilitate integration of the new tissue. More research with longer follow‐up is needed to ascertain the most successful and safe methods and materials for pelvic organ repair and SUI treatment.     

Evaluation of acupuncture treatments of postpartum female pelvic floor dysfunction by four-dimensional transperineal pelvic floor ultrasound

Introduction:In the present investigation, a systematic evaluation of the clinical treatment performance of diagnosed with pelvic floor dysfunction is explored. By comparing the 4Dtransperineal pelvic floor ultrasound images with the acupuncture treatment performance of the patients, an evaluation system with various parameters is established to provide critical information to guide the clinical treatment fpostpartum female pelvic floor dysfunction (FPFD).Methods:Eighty patients diagnosed with FPFD are divided into 2 groups. After the designated treatment to the patients, they are carefully examined using transperineal pelvic floor ultrasound. The shape and activity of bladder neck, cervix and rectum anal canal under resting, anal sphincter and Valsalva movements are observed and recorded. The morphology and continuous shape of levator ani muscle in different states after 4D image reconstruction are obtained.Results:After the acupuncture treatment, the bladder neck descent is decreased by 3.8 cm and the anal levator muscle area is decreased by 3.4 cm² comparing with the control group. The anal levator muscle hole diameter is decreased by 0.3 cm, while the anterior and posterior diameter is reduced by 0.5 cm. Reduced possibility of cystocele and uterine prolapse is demonstrated by X² test. These changes upon acupuncture therapy are in line with the improved conditions of the patients, indicating these parameters can help evaluate the therapy performance.Conclusion:4D pelvic floor ultrasound imaging provides objective and quantified information for the clinical diagnosis and treatment of FPFD and the assessment of therapy efficacy, making it a promising novel method in practical applications.     

Pelvic Organ Prolapse and Urinary Incontinence in Women With Surgically Managed Rectal Prolapse: A Population-Based Case-Control Study

Purpose This study aimed to investigate the prevalence of genital prolapse surgery and urinary incontinence in female patients operated on for rectal prolapse compared with a matched control group without rectal prolapse. Methods Fifty-two patients with a history of abdominal rectal prolapse surgery and 200 randomly selected age-matched and gender-matched control subjects without rectal prolapse received an extensive health care history survey. Results Response rate in the patient group was 48 of 52 (92 percent) and 165 of 200 (82 percent) in the control group. Rectal prolapse was associated with an increased risk of surgery for uterine prolapse (odds ratio = 3.1; 95 percent confidence interval = 1.4–6.9) and vaginal wall prolapse (odds ratio = 3.2; 95 percent confidence interval = 1.3–7.8). Mean age at hysterectomy because of uterine prolapse was 54.7 years in the patient group compared with 62.6 years in the control group (P < 0.01). Mean age at vaginal wall prolapse surgery was 60.2 years in the patient group compared with 66.6 years in the control group (P < 0.05). There were no significant differences between the cohorts regarding prevalence or age at debut of urinary incontinence. Conclusion Our results indicate a strong association between rectal and genital prolapse surgery suggesting that diagnosis of rectal prolapse necessitating surgical intervention should prompt a multidisciplinary pelvic floor assessment. Read at the meeting of The European Association of ColoProctology, Barcelona, Spain, September 18 to 20, 2003.