阴式子宫切除术加阴道部分封闭术治疗老年盆腔器官脱垂的疗效和生活质量评价

目的评价阴式子宫切除加阴道部分封闭术对无性生活要求的老年盆腔器官脱垂患者手术效果和生活质量的影响。方法2007年12月至2009年4月对北京大学第三医院妇产科20例无性生活要求的POP-Q分期Ⅲ～Ⅳ期的老年盆腔脏器脱垂患者进行阴式子宫切除+阴道部分封闭术,1例保留子宫行阴道部分封闭术。采用PFDI-20短表调查患者生活质量。结果21例患者均有Ⅲ～Ⅳ期前盆腔缺陷,16例(76.19%)Ⅲ～Ⅳ期中盆腔缺陷,4例(19.05%)Ⅲ～Ⅳ期后盆腔缺陷。平均手术时间(146.95±60.83)min,平均术中出血量(65.71±39.32)ml,术中无并发症发生。3例围手术期并发症。21例患者均完成随访,平均随访时间(11.14±5.28)个月。主观和客观治愈率均为100%。术前PFDI-20总评分为(76.82±36.46)分,术后下降为(8.87±15.33)分。术前3个分量表POPDI-6、CARDI-8和UDI-6评分分别为(38±17)分、(1.25±1.5)分、(37.5±25)分,术后分别降为(2±4)分、(0.25±0.5)分、(6.5±11.75)分。术前术后评分比较,差异均有统计学意义(P0.05)。结论对于无性生活要求的老年盆腔器官脱垂患者,采用阴式子宫切除加阴道部分封闭术,疗效肯定,可改善患者术后近期的生活质量。     

修复盆腔脏器脱垂以改善患者生活质量

盆腔脏器脱垂(膀胱，子宫，直肠)影响女性患者的生活方式。该研究通过随访及问卷调查．评估盆腔脏器脱垂修复(经阴道膀胱颈悬吊加阴道前壁修补)术后的手术效果，生活质量(QOL)以及尿动力学检查在预测术后并发症方面的作用。     

阴道封闭术治疗重度盆腔器官脱垂老年女性的尿路症状疗效评价

目的:探讨阴道封闭术治疗老年女性重度盆腔器官脱垂(POP)患者尿路症状的改善情况。方法:选择2014年1月至2017年10月北京大学人民医院采取阴道完全封闭术及阴道部分封闭术治疗老年重度POP患者286例,POP-Q法分期均为Ⅲ～Ⅳ期,分析患者手术并发症及尿路症状改善情况,并采用生活质量调查问卷(PFDI-20短表),及其分量表盆底功能障碍症状问卷排尿困扰量表(UDI-6)和盆腔器官脱垂困扰量表(POPDI-6)进行评价。结果:①286例患者年龄60～90岁,行阴道全封闭术172例,阴道部分封闭术114例。有48例同时行抗压力性尿失禁(SUI)手术。手术后平均随访时间28.30±11.70个月。随访中无POP复发者,客观治愈率100%。②手术后近远期并发症38例,发生率为13.19%(38/286)。尿潴留经保留尿管无效后电刺激治疗1例,新发SUI 13例,发生率5.86%(13/222)。③术前伴排尿困难患者45.10%(129例),与无排尿困难患者(157例)比较,术后残余尿量差异无统计学意义(47.48±54.13 ml vs 43.35±62.96 ml,P0.05);术前有排尿困难的患者其术前尿频、尿急、下腹坠痛的比例明显高于术后发生的比例,差异均有统计学意义(P0.05)。术前有排尿困难患者(129例)行阴道完全封闭术与行阴道部分封闭术比较,其术后自主排尿测残余尿差异无统计学意义(35.24±43.15 ml vs 33.84±40.59 ml,P0.05)。术后新发SUI 13例中行阴道完全封闭术与行阴道部分封闭术构成比比较,差异无统计学意义(7.21%vs 6.58%,P0.05)。④222例患者完成术后随访,阴道封闭术后PFDl-20、UDI-6、POPDl-6评分均明显低于术前(P0.05)。而阴道完全封闭术与阴道部分封闭术术后PFDl-20、UDI-6、POPDl-6评分比较,差异均无统计学意义(P0.05)。结论:阴道封闭术对高龄体弱、无性生活要求、不能耐受盆底重建术的老年患者,可显著改善患者POP及尿路症状,提高患者术后的生活质量。阴道完全封闭术和阴道部分封闭术改善患者尿路症状的效果相当。     

全盆腔悬吊术治疗盆腔脏器脱垂的临床分析

目的探讨应用全盆腔悬吊术治疗盆腔脏器脱垂,并同时进行盆底重建的可行性和有效性.方法对16例具有不同缺陷的盆腔脏器脱垂患者进行全盆腔悬吊术.结果平均手术时间65分钟,平均出血150 ml,盆腔脏器脱垂全部得到纠正,随访期间未发现有阴道缩短、扭曲等症状,性生活不受影响.1例出现宫颈延长,1例出现网片排异,余无异常.结论全盆腔悬吊术对 盆腔脏器脱垂患者在保留子宫同时进行盆底重建,简化了手术治疗的过程,手术方法简单易掌握,短期疗效肯定,长期疗效有待进一步观察和随访,值得临床进一步研究.     

重度盆腔器官脱垂患者阴道封闭术后新发压力性尿失禁的影响因素

目的:探讨重度盆腔器官脱垂(POP)患者阴道封闭术后新发压力性尿失禁(SUI)的影响因素。方法:选取2017年1月至2021年11月于甘肃省妇幼保健院生殖泌尿科因POPⅢ～Ⅳ度行阴道封闭手术并完成术后随访的104例患者临床资料进行回顾性分析,采用多因素Logistic回归分析术后新发SUI的影响因素。结果:104例患者中,术后新发SUI 22例(21.15%,22/104)(术后新发SUI组)。术后无新发SUI组与术后新发SUI组在高血压病史、术前Aa值、术前尿动力学检查(UDS)膀胱出口梗阻、术前隐匿性尿失禁(OSUI)的比较,差异有统计学意义(P<0.05)。多因素分析显示,重度POP患者阴道封闭术后新发SUI的独立危险因素包括有高血压病史(OR 4.085,95%CI 1.149～14.522,P=0.030)、术前Aa值高(OR 1.933,95%CI 1.159～3.222,P=0.012)、术前UDS膀胱出口梗阻(OR 4.439,95%CI 1.220～16.151,P=0.024)、术前UDS示OSUI(OR 4.565,95%CI 1.304～15.977,P=0.018)。结论:有高血压病史、术前Aa值高、术前UDS膀胱出口梗阻、术前UDS-OSUI是重度POP患者阴道封闭术后新发SUI的独立危险因素。对于有此类高危因素的POP患者,术前综合评估后制定合理的手术方案,必要时术中同时行抗尿失禁手术。     

女性盆腔器官脱垂术后生活质量评价及影响因素

女性盆腔器官脱垂(POP)是指由于盆底支持结构的薄弱或损伤导致的子宫及其相邻的尿道、膀胱和直肠向下移位。其导致的一系列如尿失禁、排尿困难、性生活障碍等症状将影响女性的生活质量。POP手术效果的评估除了解剖学复位外,还包括术后生活质量的改善情况。目前评估POP术后生活质量的主要方法是采用生活质量问卷。目前临床使用的问卷有许多,但何者最为权威并无统一共识。不同手术方式将对术后生活质量造成影响,但利用不同问卷可能导致不同结果。目前研究显示,术后辅以非手术治疗方式并不能显著提高生活质量。     

阴道封闭术治疗老年重度盆腔器官膨出26例临床分析

目的:探讨阴道封闭术治疗老年重度盆腔器官膨出(POP)的疗效和安全性。方法:回顾性分析北京协和医院2008年5月至2011年6月因重度POP行阴道全封闭术或阴道半封闭术治疗的26例老年患者病例资料。POP定量分度(POP-Q)法分期均为Ⅲ～Ⅳ期,平均年龄75±5岁(64～89岁)。记录围手术期参数和手术并发症,评价手术的主客观效果和患者满意度等。结果:阴道全封闭术及阴道半封闭术在手术时间和估计出血量方面差异无统计学意义(P>0.05)。所有患者均安全渡过围手术期,顺利恢复自主排尿,1例并发症为阴道血肿。术后大部分患者排尿和排便症状较术前有改善。新发压力性尿失禁1例(3.8%)。患者平均住院费用4488±990元。门诊随诊中位时间3个月(1～10个月),客观治愈率100%;电话随诊中位时间15个月(2～39个月),主观治愈率100%,患者满意率100%。结论:阴道封闭术能缓解多数患者已有的排尿、排便症状,对于无阴道性生活要求的老年重度POP患者是一种安全、经济、疗效满意的术式。     

老年妇女盆腔脏器脱垂手术治疗的临床分析

目的:探讨老年妇女子宫脱垂合并心血管、糖尿病的患者行子宫颈部分切除+部分阴道封闭术临床疗效。方法:对近两年来我院妇科收治的8例70岁以上有内科合并症的子宫脱垂患者,行子宫颈部分切除+部分阴道封闭术,观察术中、术后的并发症及治疗效果。结果:8例患者术中术后无并发症发生,术后切口愈合良好。结论:有内科合并症的子宫脱垂患者行子宫颈部分切除+部分阴道封闭术,手术方式是安全可靠的。     

网片对比传统阴道修补术治疗盆腔脏器脱垂的系统评价

目的本研究旨在系统评价网片（Mesh）治疗盆腔脏器脱垂与传统阴道修补术的有效性和安全性。方法计算机检索Cochrane Library、PubMed、EMBASE、中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊全文数据库,检索时间截至2011年10月。检索词为pelvic organ prolapsed、POP、Mesh、盆腔脏器脱垂、网片等。纳入传统手术和网片对比治疗盆腔脏器脱垂的随机对照试验,由两名研究员分别独立提取数据和进行文献质量评价,并进行meta分析。结果共纳入5篇RCTs,meta分析结果显示：网片治疗妇女盆腔脏器脱垂并未增加手术成功率[RR=1.09,95%CI（0.58,2.02）,P=0.79]、降低术后POP-Q分度[MD=0.11,95%CI（-0.15,0.36）,P=0.41],同时术后性交困难[OR=1.25,95%CI（0.54,2.87）,P=0.60]和复发率[RR=0.76,95%CI（0.10,5.28）,P=0.78]等并未降低。结论当前证据表明：与传统手术相比,网片并不能增加手术的客观成功率,亦不能降低术后POP-Q分度以及术后感染等,尚需经济学评价及适用性研究以指导临床实践。     

阴道半封闭术对老年盆腔器官脱垂患者的治疗作用

阴道半封闭术又称LeFort手术,对于高龄体弱、耐受手术能力差、不要求保留阴道功能的重度盆腔器官脱垂(pelvic organ prolapse,POP)患者是一种重要的术式.该术式简便、安全、经济,有着独有的优势和不可或缺的地位,此经典的术式术后有一定复发率,并有新发尿失禁等并发症的发生,王武亮教授团队针对LeFor...     

Pelvic organ prolapse in rural Ghana

Objective

To determine the prevalence of pelvic organ prolapse (POP) and its impact on the lives of women in Sekyidumasi, a rural Ghanaian community.

Methods

A cross-sectional study of 200 women was performed using a questionnaire and pelvic examination to detect symptoms and signs of prolapse. Main outcome measures were the presence of POP and its impact on quality of life.

Results

Out of 174 women included in the study, 21 women (12.07%) had POP. Seventeen of these women (81%) were symptomatic, of which only 6 women (35.3%) had sought treatment because of financial constraints. The odds of prolapse increased with increasing parity (P = 0.02) and age (P < 0.01). The main impacts of prolapse were on emotional well-being (52.4%), the women's relationship with their partner (46.2%), and sex life (25%).

Conclusion

Only about one-third of women with symptomatic prolapse sought treatment because the cost of medical care outweighed the impact of the condition on their lives.     

Evaluation of confounding factors interfering with sexual function in women with minimal pelvic organ prolapse

Objective

To evaluate the effects of confounding factors on sexual function in women with minimal pelvic organ prolapse (POP).

Methods

A cross-sectional study was conducted at a cervical cancer screening center in Turkey between December 1, 2012, and March 31, 2013. Symptom-free women with stage I or II POP were enrolled to evaluate the association between sexual function and sociodemographic variables, POP, POP-related quality of life, stress incontinence, and overactive bladder.

Results

Of 243 volunteers (mean age 46.0 ± 9.1 years), 188 (77.4%) had a low Female Sexual Function Index score. Women with better sexual function tended to be younger, have a higher salary, not be in the menopause, and have no chronic illness (P < 0.05 for all). There was no difference between the groups in terms of POP Quantification measurements (P > 0.05), apart from transvaginal length (P = 0.011). Overactive bladder was more common (P = 0.005) and more severe (P = 0.002) in women with sexual dysfunction, and their POP-related quality of life was worse (P < 0.05). In a linear regression analysis, high salary had a positive effect and overactive bladder had a negative effect on sexual function.

Conclusion

Sexual dysfunction is highly prevalent in women with minimal POP. Overactive bladder and low income are the major factors adversely affecting sexual function.     

盆底重建术中应用补片对患者生活质量影响的评价

目的 评价应用合成补片进行盆底重建手术对患者生活质量的影响.方法 2006年3月～2007年8月我科应用合成补片对POP-Q分期Ⅲ～Ⅳ期的盆腔脏器脱垂患者进行盆底重建手术.患者术前及术后填写生活质量调查问卷(PFDI-20短表).术后定期复查,判定主客观复发情况.采用单因素方差分析、配对资料的t检验.结果 可进行生活质量评价的盆底重建手术患者39例.前盆腔缺陷92.3%,中盆腔缺陷74.4%,后盆腔缺陷33.3%.术前PFDI-20总评分(15.05±6.77)分,手术后2个月、半年、1年和1年半的PFDI-20评分分别降为(1.48±4.20)分、(4.44±5.93)分、(2.46±2.60)分和(3.40±2.79)分,P均＜0.05,而术后各组的评分间差异无统计学意义,(P＞0.05).术后POPDI-6(盆腔脏器脱垂)、CARDI-8(肠道脱垂)和UDI-6(排尿相关症状)评分下降,与术前相应评分相比,差异具有显著意义(P＜0.05).36例患者随访2～17个月(平均7.1个月),近期主观治愈率100%,客观治愈率97.2%.无补片侵蚀发生.结论 盆腔脏器脱垂对患者的生活质量有明显影响,盆底重建手术中使用补片疗效肯定,可显著改善患者术后近期的生活质量.但需要延长随访时间,观察长期疗效.     

经阴道子宫骶骨韧带高位悬吊术治疗重度盆腔器官脱垂的长期疗效

目的 探讨经阴道子宫骶骨韧带高位悬吊术(HUS)治疗重度盆腔器官脱垂(POP)的长期主、客观疗效.方法 2003年6月至2013年3月,解放军总医院第一附属医院共对136例POP定量(POP-Q)分度法Ⅲ～Ⅳ度的POP患者行经阴道子宫切除及HUS,对获得随访的125例患者的临床资料进行回顾性分析.阴道前壁修补99例(79.2％,99/125),其中前壁Ⅲ度以上脱垂者中65％(53/81)加用了网片,后壁修补80例(64.0％,80/125),后壁Ⅲ度以上脱垂者中15％(5/34)加用网片.47例术前有压力性尿失禁者同时行耻骨后或经闭孔阴道无张力尿道中段悬吊带术,96.0％(120/125)的患者同时行肛提肌及会阴体修补术.术后5年对患者的主、客观疗效进行回顾性分析,包括围手术期情况以及近远期并发症.手术客观治愈标准为脱垂器官最远端与处女膜水平的距离＜0 cm;主观改善情况通过比较患者手术前、后盆底疾病生命质量影响问卷简表(PFIQ-7)和盆底功能障碍性疾病症状问卷简表(PFDI-20)评分.结果 125例患者平均随访时间(5.4±1.2)年.术后5年中有4例患者阴道前壁轻度膨出,复发率为3.2％ (4/125),但不需再次手术及子宫托治疗.术后5年客观治愈率为96.8％(121/125),主观满意度为94.4％(118/125),PFDI-20,PFIQ-7调查问卷中位评分分别为8、7分,均较术前(分别为62、64分)明显降低(P＜0.01),提示主观症状明显改善.术中3例(2.4％,3/125)患者输尿管被缝扎.术前47例压力性尿失禁患者中术后2例症状未改善,其中1例半年后好转.2例(1.6％,2/125)新发轻度尿失禁,但不需要治疗.结论 HUS用于治疗重度POP疗效持久,主、客观治愈率高,复发率低,安全、有效,值得临床推广应用.     

Self-perceived quality of life after pelvic organ prolapse reconstructive mesh surgery: prospective study

Objective

To assess the self-perceived quality of life in women with advanced pelvic organ prolapse before and after mesh surgery.

Study design

Women with symptomatic pelvic organ prolapse (stage III–IV according to pelvic organ prolapse quantification (POP-Q)) were invited to participate in the study. All enrolled patients underwent prolapse surgery using the transvaginal mesh technique. Success was defined as ICS POP-Q stage 0 and I. The SF36v2 questionnaire was used as a subjective outcome measure.

Results

113 patients were available for follow-up at 6–8 weeks and 16–18 months. Overall anatomic success rates were 87.6%. Statistically significant improvements in the self-perceived quality-of-life were found in 3 individual domains (general health (GH), vitality (V) and mental health (MH)) and in one summary domain (MCS) at 6–8 weeks post-op. In one individual and one summary domain (role – physical (RP) and physical component summary (PCS)) the scores were significantly lower. At the end of the study statistically significant improvement was observed in four out of eight individual domains (vitality (V), menthal health (MH), physical functioning (PF), social functioning (SF)) as well as in both summary scores (PCS and MCS).

Conclusions

Reconstructive mesh surgery improved significantly various self-perceived quality of life dimensions. Therefore, women should expect significant improvement in their general quality of life after this type of operation. The assessment of urogenital well-being should be a routine attitude when counseling menopausal women.     

Adoption of the pelvic organ prolapse quantification system in peer-reviewed literature

OBJECTIVE: The purpose of this study was to examine the method of describing pelvic organ prolapse in the peer-reviewed literature since the introduction of the Pelvic Organ Prolapse Quantification System (POPQ). STUDY DESIGN: Representative US and international gynecology and urology journals were selected for review. All prolapse or urinary incontinence articles published in these journals from January to December of 1999 (period 1) and July 2001 to June 2002 (period 2) were hand searched by two independent reviewers. Systems for grading the severity of pelvic organ prolapse were separated into the following categories: POPQ, Baden-Walker system, Beecham system, grade without reference, or nonstandardized system. Chi-square and Fisher exact tests were used for statistical analysis. RESULTS: A prolapse staging system was not referenced, or a nonstandardized staging system was used in 54.8% of studies. Overall, the POPQ system was the most common system used (22.6%), followed by the Baden-Walker system (19.8%). There was a statistically significant increase in the use of POPQ from period 1 (13.3%) to period 2 (28%) (P=.03). Articles published in gynecology journals were more likely to use the POPQ system than those published in urology journals (29% vs. 14%, P=.009). CONCLUSION: POPQ was the most common system used; however, the staging system was not cited or a nonstandardized staging system was used in more than half of studies.     

Cutoff score of the traditional Chinese version of the short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12)

ObjectiveThe short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) is a condition-specific instrument used to evaluate sexual function in women with pelvic floor disorders. The traditional Chinese version of the PISQ-12 (CVPISQ-12) has been validated, however the cutoff score has yet to be determined. The aim of this study is to establish the cutoff score for the CVPISQ-12 and analyze the risk factors for female sexual dysfunction.Material and methodsA sub-analysis of data involving sexually active women who sought consultation for pelvic floor disorders at a medical center in 2016. Based on the known cutoff value of Female Sexual Function Index, the cutoff score of the CVPISQ-12 was analyzed using receiver operating characteristic (ROC) curve analysis. Other assessments included 1-h pad test and incontinence-related questionnaires using the short forms of the Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7).ResultsROC curve analysis showed a cutoff score of 32.5, with a sensitivity of 87% and specificity of 88%. The area under the ROC curve was 0.937 (p <0.001; 95% confidence interval: 0.895–0.979). The 1-h pad test (B = −0.266; p = 0.031), IIQ-7 (B = −0.378; p = 0.047) and age (B = −0.415; p = 0.001) were risk factors for sexual dysfunction in women with a score <32.5. However, age was the only significant risk factor for women with a higher score (B = −0.384; p = 0.035).ConclusionsA CVPISQ-12 score ≥32.5 suggested normal sexual function. For this patient group, age may be a more important factor associated with sexual function than pelvic floor disorders.     

Surgical repair of pelvic organ prolapse and follow-up: An institutional multi-center experience

AIM: To investigate the effects of the Elevate Anterior and Posterior transvaginal mesh procedure on 30 patients affected by pelvic organ prolapse (POP) at 12 mo follow-up. METHODS: Between September 2011 and September 2012, a prospective multicenter observational study enrolled 30 consecutive patients with POP-Q ≥ stage II. After a preoperative evaluation, patients underwent prolapse repair utilizing the Elevate Anterior and Posterior Prolapse Repair System (American Medical Systems, Minnetonka, MN, United States). Operative technique was standardized and performed by the same surgical team under spinal or general anesthesia. Patients were evaluated postoperatively at 1, 3, 6 and 12 mo. RESULTS: All 30 patients completed the 12 mo follow-up. The mean age was 65.3 years (range 49-81 years) and average hospital stay was 4.5 d. The mean operative time was 65 min (range 40-120 min). Related adverse events reported were mesh extrusions (6.7%) and post void residual urine volume (13.3%). There were no visceral injuries, no infection of the mesh, and no symptoms of recurrent prolapse. All quality-of-life scores significantly improved from baseline. CONCLUSION: One year’s follow-up of our 30 patients confirms the safety and the efficacy of the Elevate Anterior and Posterior transvaginal mesh procedure for POP treatment. Our final results are comforting but longer term follow-up is ongoing.     

Reutilization of the Prolift mark system for the simultaneous correction of prolapse and incontinence in patients with pelvic organ prolapse and stress urinary incontinence

Objective

The reutilization of the Prolift™ system with the simultaneous creation of a midurethral sling from the same set was described.

Study design

The technique was applied in 23 patients with pelvic organ prolapse (POP) and clinically evident or occult stress urinary incontinence (SUI).

Results

Correction of POP was achieved in 21 out of 23 (91.3%) patients, and complete continence after the surgery in 20 out of 23 (86.9%). There was a significant improvement in voiding symptoms without deterioration of voiding function. Morbidity of the surgery was not different from that with Prolift™ alone.

Conclusion

Modification of the method with creation of a suburethral sling from the same set is more economically viable without compromising either pelvic organ support or continence.