产后早期盆腔器官脱垂发生的预测模型构建及验证

目的:分析产后早期发生盆腔器官脱垂（POP）的高危因素并构建预测模型。方法:横断面调查北京大学人民医院2018年12月至2019年10月期间产后6周妇女（2 247例）的临床资料和POP现状并采用logistic回归分析产后POP发生的相关影响因素,构建产后早期POP发生的预测模型并进行内部验证;另采集2019年11—...     

初产妇产后早期盆腔器官脱垂的高危因素分析

目的：探讨初产妇足月阴道分娩后产后早期盆腔器官脱垂（POP）发生的高危因素。方法：选取2017年1-4月在上海交通大学医学院附属国际和平妇幼保健院产后6～8周复诊的经阴道足月分娩的初产妇1 216例。同时行盆腔器官脱垂定量分度法（POP-Q）评分,按评分结果分为POP组（644例）和对照组（572例）,采用单因素和多因素Logistic回归分析各种产科因素与产后早期发生POP的相关性。结果：在1 216例阴道分娩的初产妇中,POP的发生率为52.96%（644/1 216）;POP组的年龄、分娩孕周、新生儿出生体质量以及产钳助产率显著高于对照组,差异有统计学意义（均P＜0.05）;而2组产妇孕前体质量指数（BMI）、孕期体质量增加量、产时BMI、第二产程时间、是否会阴裂伤和是否会阴侧切比较,差异均无统计学意义（均P＞0.05）。多因素Logistic回归分析显示,与年龄＜28岁的产妇相比,年龄≥36岁的产妇产后早期POP的发生风险显著升高（OR=2.352,P=0.010,95%CI：1.222～4.526）;与新生儿出生体质量＜3 000 g的产妇相比,新生儿出生体质量为3 500～3 999 g和≥4 000g的产妇产后POP的发生风险均显著增加（OR=2.039,P=0.000,95%CI：1.385～3.003;OR=2.676,P=0.007,95%CI：1.303～5.495）;与自然分娩的产妇相比,行产钳助产的产妇产后POP发生风险显著升高（OR=1.760,P=0.019,95%CI：1.097～2.823）。结论：初产妇阴道分娩产后POP的发生与年龄、新生儿出生体质量以及产钳助产有关。阴道分娩产后POP发生率高,应加强产妇盆底疾病的预防及重视产后康复训练,尤其是有高危因素的产妇。     

盆腔器官脱垂发病相关因素研究进展

随着人口老龄化．盆腔器官脱垂（POP）在临床上日益多见，了解其发病原因在临床上具有积极的预防和治疗意义。近年研究发现，除常见的分娩损伤、腹内压增加和衰老外，遗传和医源性因素也是重要的高危因素。结缔组织疾病、先天性阴道直肠膈缺损或有POP一级家族史者患病率增加，提示遗传因素的重要性。子宫切除术后可能出现阴道穹隆脱垂，前盆腔重建术时，如阴道前壁修补术、阴道旁修补术、Burch手术和阴道无张力吊带类手术将使阴道轴向前移位屈曲，易促发肠膨出；而阴道后壁修补术，尤其是骶棘韧带固定术则有可能使阴道轴向后移位，易发生阴道前壁膨出。     

女性盆底解剖及盆腔器官脱垂诊断评估模式

掌握女性盆底解剖是了解盆腔器官脱垂发病机制的关键,诊断并评估相关盆底解剖缺损是制定个体化治疗方案的前提,文章简述女性盆底解剖结构,探讨盆腔器官脱垂的诊断评估模式及手术方式。     

女性盆腔器官脱垂Prolift网片盆底重建术

盆腔器官脱垂(pelvic organ prolapse,POP)是老年妇女的常见病,随着人口的老龄化,盆腔器官脱垂的发病率在逐步增高,并已严重影响中老年妇女的生存质量。手术仍为迄今为止最为有效的治疗方法,在发达国家POP的修复重建手术已占到普通妇科大手术的40%~60%。传统的手术是以缓解症状     

盆腔器官脱垂发病相关因素研究进展

随着人口老龄化,盆腔器官脱垂(POP)在临床上日益多见,了解其发病原因在临床上具有积极的预防和治疗意义.近年研究发现,除常见的分娩损伤、腹内压增加和衰老外,遗传和医源性因素也是重要的高危因素.结缔组织疾病、先天性阴道直肠膈缺损或有POP一级家族史者患病率增加,提示遗传因素的重要性.子宫切除术后可能出现阴道穹隆脱垂,前盆腔重建术时,如阴道前壁修补术、阴道旁修补术、Burch手术和阴道无张力吊带类手术将使阴道轴向前移位屈曲,易促发肠膨出;而阴道后壁修补术,尤其是骶棘韧带固定术则有可能使阴道轴向后移位,易发生阴道前壁膨出.     

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。     

盆腔器官脱垂的盆底缺陷诊断

盆腔器官脱垂是由于盆底支持结构薄弱导致的盆腔器官移位而引发的一系列临床症状。同样的脱垂症状可能是不同盆底组织结构缺陷的结果,只有诊断明确才能选择正确的术式,制定个体化的临床方案,提高治愈率,降低并发症和复发率。     

盆腔器官脱垂的危险因素研究进展

盆腔器官脱垂(pelvic organ prolapse,POP)是由多因素导致盆底支持组织损伤而引发的复杂疾病,临床表现为盆腔器官位置下移及功能异常。POP现已严重影响广大女性尤其是中老年女性的生活质量,增加了家庭经济负担。因此,减少POP的发生、发展是当下亟需解决的问题。已有研究表明,高龄、肥胖、种族、阴道分娩、产钳助产、第二产程延长、巨大儿、家族史、遗传史等可能是POP发生的危险因素;产次、重体力劳动、慢性咳嗽、便秘、高血压、糖尿病等对POP造成的影响目前尚存在争议。综述POP的危险因素,以期为相关干预措施及卫生政策的制定提供科学依据。     

盆腔器官脱垂及压力性尿失禁的相关因素分析

目的:探讨盆腔器官脱垂及压力性尿失禁的相关危险因素。方法:选择2007年1月至2016年1月在郑州大学第三附属医院盆底重建科行盆底重建术患者625例,将其中盆腔器官脱垂患者454例为A组,压力性尿失禁患者171例为B组,另选择体检的健康女性449例为对照组。分别统计分析其孕产次,是否绝经,有无子宫切除、慢性高血压、糖尿病、会阴裂伤、子宫肌瘤及阴道分泌物分析结果等资料,并进行单因素和多因素Logistic回归分析。结果:单因素分析示:A组子宫切除、已绝经、会阴裂伤患者所占比例均明显高于对照组(P0.05);B组慢性高血压、会阴裂伤的患者所占比例均明显高于对照组(P0.05);A组、B组多孕次(≥3次)、多产次(≥3次)患者所占比例高于对照组(P0.05),存在乳杆菌患者所占比例低于对照组(P0.05)。多因素Logistic回归分析示:子宫切除、已绝经、会阴裂伤、孕次≥3次、产次≥3次是盆腔器官脱垂的独立危险因素;会阴裂伤、孕次≥3次、产次≥3次是压力性尿失禁的独立危险因素。存在乳杆菌是盆底器官脱垂和压力性尿失禁的保护因素。结论:子宫切除、多孕、多产、会阴裂伤可能参与了盆腔器官脱垂及压力性尿失禁的发生发展,阴道乳杆菌的存在可能减少盆腔器官脱垂及压力性尿失禁的发生。     

Perioperative Complications in Vaginal Mesh Procedures Using Trocar in Pelvic Organ Prolapse Repair

Introduction and Hypothesis

This study aimed to document intraoperative and early postoperative complications associated with the use of vaginal mesh with trocar in pelvic organ prolapse (POP) repair.

Methods

This is a retrospective review of 120 cases of vaginal repair of POP using vaginal mesh. Of the 120 patients, 31 underwent anterior mesh repair (Light mesh 10, Avaulta 1, Perigee 1, and Prolift 19); 35 underwent posterior mesh repair (Light mesh 2, Posterior IVS 17, and Prolift 16); and 54 underwent anterior and posterior mesh (total) repair (Light mesh 8, Prolift 32, and Prolift M 14).

Results

Three bladder injuries (2.5%) and one distal rectal injury (0.8%) occurred during dissection. Three of four organ injuries (75%) had previous prolapse repair. Overall four patients (3%) required transfusion. Urinary retention exceeding 5 days occurred in four patients. Three of them (60%) also underwent TVT-O. Groin pain occurred in two patients one of whom underwent TVT-O. Gluteal pain occurred in one patient. Early mesh exposure occurred in the vaginal cuff of a patient who underwent hysterectomy.

Conclusions

The vaginal mesh procedures may be done with relatively few perioperative complications. However, there is a need for more randomized controlled trials with long-term follow-up to clarify its postoperative long-term complications and morbidities.     

盆腔器官脱垂患者生活质量的影响因素研究现况

盆腔器官脱垂（pelvic organ prolapse,POP）是指由于盆底支持结构薄弱或损伤导致的子宫及其相邻的尿道、膀胱和直肠位置的下移,从而产生一系列如尿失禁、排尿困难、性生活障碍等症状。POP为中老年女性多发的一类良性疾病,其发病率高、治疗费用高昂、社会经济及医疗负担沉重,严重影响着女性患者的生活质量。随着近年来妇科泌尿学的发展及盆底重建外科学等取得的显著成果,POP的发病机制、诊断、治疗及疾病相关危险因素等方面的研究已经取得重大突破。目前,对POP生活质量的研究大多为经盆底外科手术或盆底物理治疗等干预后的评估性分析,尚缺乏较深入的研究。相关研究表明,POP症状的严重程度、外科手术史、盆底康复治疗、肥胖、是否合并其他类型盆底疾病及心理障碍可能为影响POP患者生活质量的重要因素。综述POP患者生活质量的影响因素,以期为相关临床干预措施的制定提供理论基础。     

阴道无张力尿道中段悬吊术与单纯盆底修复手术治疗压力性尿失禁临床疗效比较

目的:比较压力性尿失禁合并盆腔脏器脱垂(POP)的患者,行阴道无张力尿道中段悬吊术(TVT)与单纯盆底修复术的疗效差异。方法:32例压力性尿失禁或同时伴有不同程度盆腔脏器脱垂的患者,20例接受TVT手术,12例未行TVT手术,只进行了盆底修复或(和)其他妇科手术,术前、术后进行评估。结果:手术总时间、术中出血量、术后住院时间,两组患者之间没有统计学差异。TVT组术中出现膀胱穿孔1例,术后两组均无严重并发症。TVT组随访4~26个月,90%完全治愈,10%明显改善。单纯修复组随访7~24个月,治愈率66.7%,1例复发,1例加重。结论:TVT治疗女性压力性尿失禁是一种安全、有效的手术,与盆底修复同时进行可显著提高压力性尿失禁的治愈率。     

The Effect of Vertical Versus Horizontal Vaginal Cuff Closure on Vaginal Length After Laparoscopic Hysterectomy

Study Objective

To determine whether vertical versus horizontal closure of the vaginal cuff during laparoscopic hysterectomy has an effect on postoperative vaginal length and pelvic organ prolapse.

Vaginal Vault Prolapse Following Hysterectomy

Abstract: in the last century many different operations were described to correct post hysterectomy vaginal vault prolapse. We analyzed the results of post hysterectomy vaginal vault prolapse repair at our centre, to compare the results of the abdominal colposacropexy to a vaginal approach using the Mayo culdoplasty technique. We also present a literature review of other surgical techniques to correct prolapse of the vagina.Methods: the charts of 78 patients with posthysterectomy vaginal vault prolapse presenting for surgical correction between February 1993 to November 1998 were reviewed. Follow-up phone interview and/or clinical examinations were performed to evaluate patient satisfaction and long-term outcome.Results: the mean age at operation was 67 years. Abdominal hysterectomy had been performed on 69 percent of the patients. The mean time elapsed from hysterectomy to vault prolapse repair was 19.93 years. Abdominal colposacropexy was performed on 24 percent of the patients. The Mayo culdoplasty technique was used in 76 percent of patients. There were few perioperative and postoperative complications. Follow-up ranged from one to 58 months.Conclusion: vaginal vault prolapse repair by the abdominal colposacropexy and the Mayo culdoplasty are safe and effective procedures. Anatomical restoration and patient satisfaction were achieved in the majority of patients.     

Vaginal mesh colpopexy for the treatment of concomitant full thickness rectal and pelvic organ prolapse: a case series

Objective

To present our case series of concomitant rectal and pelvic organ prolapse (POP) treated with vaginal colpopexy with synthetic mesh.

Study design

Charts of patients with full thickness rectal prolapse and POP were reviewed for presenting symptoms, physical examination with POP-Q including rectal prolapse evaluation, and perioperative complications and outcomes.

Results

Four patients aged 63-78 were identified with full thickness rectal prolapse and POP. All of them had symptoms related to both conditions. Rectal prolapse protrusion ranged from 2 cm to 3 cm outside the anus. All patients had vaginal mesh colpopexy; two of them with anterior and posterior vaginal mesh and 2 with posterior mesh only. At a follow-up of 6-44 months, all patients had resolution of both POP and rectal prolapse signs and symptoms.

Conclusion

Vaginal colpopexy with mesh may be a unique treatment to address both POP and full thickness rectal prolapse in selected patients. Further research is needed to determine the safety and efficacy of this method.     

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.     

Comparative Study to Evaluate the Intersystem Association and Reliability Between Standard Pelvic Organ Prolapse Quantification System and Simplified Pelvic Organ Prolapse Scoring System

Purpose

The purpose of this study was to determine the association between the standard pelvic organ prolapse quantification (POPQ) classification system and the simplified pelvic organ prolapse (S-POP) classification system.

Method

This is an observational study, in which 100 subjects, whose average age was 60 ± 10 years, with pelvic floor disorder symptoms underwent two systems of examinations—POPQ classification system and S-POP classification system at Safdarjung hospital—done by four gynecologists (two specialists and two resident doctors) using a prospective randomized study, blinded to each other’s findings. Data were compared using appropriate statistics.

Results

The weighted Kappa statistics for the intersystem reliability of the S-POP classification system compared with standard POPQ classification system were 0.82 for the overall stage: 0.83 and 0.86 for the anterior and posterior vaginal walls respectively; 0.81 for the apex/vaginal cuff; and 0.89 for the cervix. All these results demonstrate significant agreement between the two systems.

Conclusion

There is almost perfect intersystem agreement between the S-POP classification system and the standard POPQ classification system in respect of the overall stage as well as each point within the same system.