手术治疗盆腔器官脱垂62例疗效观察

目的观察手术治疗盆腔器官脱垂的临床效果。方法盆腔器官脱垂患者62例,经阴道行穹窿单侧骶棘韧带固定术27例,经阴道行子宫骶韧带穹窿悬吊术20例,行腹腔镜下子宫骶韧带穹窿高位悬吊术8例(其中3例保留子宫同时行圆韧带缩短术),行经腹自体筋膜宫颈骶骨固定术7例;如有阴道缺陷,同时进行修补。结果 1例术中骶韧带未能辨认,改行阴道残端骶棘韧带悬吊术;2例因骶棘韧带缝合困难,改单侧髂尾肌筋膜固定术;59例手术顺利;随访1～3 a,1例半年后复发,其余患者POP-Q分期均在Ⅱ期以内。结论手术治疗盆腔器官脱垂疗效满意。     

两种术式治疗女性重度盆腔器官脱垂的疗效

目的比较prolift盆底重建系统与传统阴式子宫全切术及阴道前后壁修补术加骶棘韧带悬吊术治疗女性重度盆腔器官脱垂的应用效果。方法回顾分析该院2009年1月至2011年9月治疗患有POP-Q分期Ⅲ～Ⅴ期的患者30例,其中采用prolift盆底重建术14例,其他患者采用传统术式,比较两组患者的手术效果、术后并发症、手术情况(手术时间及出血量),并进行统计学分析。结果 Prolift组手术时间及出血量明显少于阴式子宫全切术及阴道前后壁修补术加骶棘韧带悬吊术组(P<0.05),POP-Q分期评价两组患者术后阴道Aa、Ba、C、Ap、Bp位点均得到显著改善,解剖疗效明显。结论两种术式应用于纠正女性重度盆腔器官脱垂都是安全可行的,但术后复发率、手术时间、手术出血量、手术并发症等方面,pro-lift盆底重建系统优于传统阴式子宫全切术加阴道前后壁修补术及骶棘韧带悬吊术。     

骶棘韧带悬吊术治疗中老年盆腔脏器脱垂性疾病27例

既往临床多采取经阴道子宫切除及阴道前后壁修补进行盆腔脏器脱垂治疗,但此术式复发及阴道顶端脱垂的问题日益突出,使之不能成为理想术式.同时老年人手术范围不宜太大,寻求一种符合中老年人特点,创伤小,效果好的手术方法成为研究热点.目前国外采用骶棘韧带悬吊术( sacrospinous ligament fixation,SSLF)治疗盆腔脏器脱垂[1],本文拟回顾分析盆腔脏器脱垂患者行骶棘韧带悬吊术的疗效.     

Avaulta前盆底修复联合经阴道骶棘韧带悬吊术对老年妇女子宫脱垂治疗后生活质量及性功能的影响

目的探讨Avaulta前盆底修复联合经阴道骶棘韧带悬吊术对老年妇女子宫脱垂治疗后生活质量及性功能的影响。方法选取老年子宫脱垂患者,根据随机数字表法分为观察组(30例)、对照组(30例),对照组给予阴道骶棘韧带悬吊术,观察组给予Avaulta前盆底修复联合经阴道骶棘韧带悬吊术。比较两组治疗后的疗效、生活质量及性功能等,并分析预后情况。结果治疗后观察组总有效率显著高于对照组(P0.05)。观察组手术时长、术中失血量及住院时间均低于对照组,但差异不显著(P0.05)。治疗后女性性功能量表(FSFI)评分、功能疗效及生活质量显著改善,观察组术后12个月的FSFI、盆底功能影响问卷简表(PFIQ)-7、障碍问卷短表(PFDI)-20评分显著优于对照组(P0.05)。经治疗后各指示点位置(除阴道总长度)均显著改善,其中观察组改善程度均显著优于对照组(P0.05)。两组随访12个月后均存在子宫脱垂(Ⅲ期及以上)、尿失禁及网片侵蚀等情况,两组发生率无统计学差异(P0.05)。结论 Avaulta前盆底修复联合经阴道骶棘韧带悬吊术治疗老年患者子宫脱垂效果显著,可有效复位子宫位置,提高性功能,从而改善生活质量,有利于预后。     

阴道骶棘韧带悬吊术治疗子宫和阴道穹隆脱垂

目的探讨经阴道骶棘韧带悬吊术治疗子宫脱垂和阴道穹隆脱垂的临床意义。方法2003年5月至2006年12月，对46例中、重度子宫脱垂和阴道穹隆脱垂患者行经阴道骶棘韧带悬吊术，术后1、3、6、12个月定期随访。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阴道顶端位于坐骨棘水平。结果平均手术时间45min（30～90min），术中平均失血量105ml（60-200ml），手术无膀胱、直肠损伤。术后平均住院时间4．7d（4～8d），导尿管引流平均2．3d（2～7d）。术后随访1～42个月，平均10个月，主观治愈率和客观治愈率均为98％。结论对子宫脱垂和阴道穹隆脱垂患者，采用阴道骶棘韧带悬吊术是一种安全、有效的治疗方法。     

全盆底重建术治疗老年妇女子宫或阴道脱垂的临床研究

女性盆底功能障碍性疾病（pelvic floor dysfunction,PFD）是由于各种原因所致支持盆底组织的结缔组织或韧带损伤,进而盆腔脏器移位引发其他盆腔内器官的位置和功能异常的一类疾病。近年来基于吊床理论的盆底重建手术为这一类疾病的治疗带来了新的视角,已有研究显示术后复发率显著降低,但随之而来的新的手术并发症也备受关注。本研究旨在探讨全盆底重建术治疗老年妇女子宫或阴道脱垂的临床疗效。     

全骨盆底悬吊术在女性骨盆底功能重建中的应用

目的探讨利用全骨盆底网片悬吊术治疗女性盆腔脏器脱垂并进行骨盆底重建的可行性和有效性。方法对2005年1月至2006年6月确诊为盆腔脏器脱垂的53例患者采用蝶形聚丙烯网片进行经阴道全骨盆底悬吊术,根据临床检查及主诉对手术前后脱垂情况进行评估,观察疗效并定期随访。结果手术时间平均97min,出血量平均160ml,53例均在术后2～6d出院,术后1、3、9、12个月随访,根据国际尿控协会制定的盆腔脏器脱垂定量分度法客观评估子宫脱垂、阴道前后壁膨出等症状全部得到纠正,无复发、无阴道扭曲和缩短、无性生活障碍,满意度达94．3％。结论全骨盆底网片悬吊术是经阴道的微创手术,对盆腔脏器脱垂患者在保留子宫的同时进行骨盆底功能重建,复发率低,值得临床进一步推广。     

磁共振成像在女性盆底功能障碍性疾病诊断中的价值

盆底功能障碍性疾病是指因盆底支持系统退化、损伤所致松弛而引发的一类疾病的总称,子宫阴道及直肠的异常下降可导致尿失禁、排便困难及盆腔器官脱垂。约50％50岁以上中老年女性受盆底功能障碍性疾病的困扰［1～3］。盆底功能障碍性疾病的病因复杂,其危险因素包括妊娠、产次、大龄、绝经、肥胖、连接组织功能失调、吸烟、慢性阻塞性肺疾病及任何其他可以导致慢性腹内压增加的疾病。盆底支持结构包括盆底肌肉、筋膜及韧带。盆底支持结构的松弛将导致盆腔器官的异常下降,从而引起尿失禁、排便困难、性功能障碍及盆腔器官脱垂等症状。盆底功能失调往往累及盆腔多个器官,美国国立卫生研究院发表声明,将年龄、性别及经阴道分娩次数定为明确的危险因素［4］。盆腔磁共振成像（ MRI）技术具有无创、软组织分辨率高、可直观显示盆腔器官及其支持结构等优点,可为盆腔器官脱垂范围和严重程度提供有价值的信息,是诊断盆底功能障碍性疾病的首选检查方法。本文就MRI在评估女性盆底功能障碍性疾病中的价值和研究现状予以综述。     

保留子宫全盆底重建26例

随着人口老龄化加快,女性盆底功能障碍成为影响中老年妇女生活质量的常见病,传统行阴式子宫切除加阴道前后壁修补治疗盆腔脏器脱垂,近年来随着盆底整体理论的丰富,宫颈周围环在维持盆底功能稳定中的作用越来越被人们重视.根据这一理论,我院妇科采用保留子宫的全盆底重建术治疗复杂性盆底功能障碍性疾病,取得良好效果.     

全盆底网片悬吊术治疗老年妇女盆腔器官脱垂疗效观察

目的观察全盆底网片悬吊术治疗老年妇女盆腔器官脱垂（POP）的疗效。方法对15例同时伴有子宫（穹窿）、阴道前后壁脱垂的POP患者行全盆底网片悬吊术治疗。结果 15例患者手术顺利,手术时间68～150min,术中出血量150～500 ml,无输血病例,无直肠及膀胱损伤。住院时间5～9 d。术后随访1～18个月,盆底结构正常,POP均未复发。4例器官脱垂症状改善,5例腰骶部不适消失,9例便秘消失,11例压力性尿失禁治愈。术后发生网片侵蚀伴阴道分泌物增多症状1例,修剪侵蚀的网片后恢复正常。结论全盆底网片悬吊术治疗老年妇女POP能实现全盆底解剖和功能重建,近期疗效较好。     

Pelvic organ prolapse: a review

Pelvic organ prolapse is a common medical problem in parous women. This condition usually refers to a combination of deficiencies of the pelvic organs as they relate to support mechanisms of the vaginal wall. Symptoms vary--an accurate diagnosis requires a careful and complete physical examination with attention directed toward the pelvis and perineum. Although many patients will not require surgical treatment for pelvic organ prolapse, a comprehensive approach to repair in which all of the anatomic defects affecting support are addressed is necessary for successful treatment. Patients presenting with pelvic organ prolapse often provide some of the most complex, challenging, and rewarding cases in reconstructive pelvic surgery. This article addresses the definitions and classifications, prevalence and risk factors, and anatomy and pathophysiology relevant to pelvic organ prolapse. Discussion also includes diagnosis and approaches to management (surgical and nonsurgical) of anterior vaginal wall prolapse, cystourethrocele, apical vaginal prolapse, uterine prolapse and enterocele, posterior vaginal wall prolapse, rectocele, and pelvic floor relaxation and perineal laxity, with indications for and approaches to surgery, along with possible complications.     

Role of pelvicography and colpocystodefecography in diagnosis of outlet obstructive constipation

Aims The aim was to research the changes in pelvic floor morphology and corresponding visceras in patients with outlet obstructive constipation (OOC).Patients and methods Thirty-eight patients with OOC and 12 healthy volunteers were enrolled in this study. With simultaneous pelvicography and colpocystodefecography (PCCD), including pelvicography, vaginal opacification, voiding cystography and defecography, pelvic floor morphology was observed and the anorectal angle, the level of the perineum, peritoneum and bladder were measured.Results Thirty-seven cases of internal rectal prolapse (IRP), 5 cases of rectocele (RC) and 5 cases of spastic pelvic floor syndrome SPFS were diagnosed by PCCD. 12 IRP, 4 RC and 1 SPFS were detected by common physical examination. All of these were confirmed by PCCD. Moreover, PCCD found 9 pelvic floor hernia or peritoneoceles, 6 cystoceles, 3 descending perineum syndromes and 10 uterine prolapses. Compared with controls, OOC patients had a significantly large anorectal angle during defecation, abnormal descending of the perineum at rest and during defecation, and a deep pouch of Douglas during defecation. Some patients with urinary system symptoms may have had an abnormal descent of the bladder during rest and defecation.Conclusion Simultaneous PCCD has a higher positive ratio than the common physical examination in diagnosing IRP and RC, and provides information for the diagnosis of pelvic floor hernia or peritoneocele, cystocele or uterine prolapse. PCCD is helpful in the selection of a proper surgical procedure.     

Management of pelvic organ prolapse

Symptomatic pelvic organ prolapse can afflict up to 10% of women. Urinary incontinence, voiding dysfunction or difficulty possibly related to bladder outlet obstruction are common symptoms. Infrequently hydronephrosis or defecatory dysfunction can be seen. The management of pelvic organ prolapse (POP) should start with adequate assessment of all pelvic floor complaints. If a patient is not symptomatic, surgical intervention is usually not indicated. While the use of a variety of graft materials are available today including porcine, dermal and synthetic grafts, that are used in some surgical approaches to pelvic organ prolapse, other more conservative approaches may prove beneficial to many patients. This article describes our approach to the patient with pelvic organ prolapse.     

Successful treatment of locally advanced bulky cervical cancer complicated by irreducible complete uterine prolapse: A case report

Rationale:Cervical cancer complicated by irreducible complete uterine prolapse in elderly patients is extremely rare. No standard treatment has been established for these conditions.Patient concerns:A 74-year-old woman with a 30-year history of pelvic organ prolapse presented with irreducible complete uterine prolapse and a large exophytic mass involving the cervix and vaginal wall.Diagnosis:Biopsy of the mass was performed at the referring institution and showed invasive verrucous-type squamous cell carcinoma.Interventions:A prolapsed uterus with a tumor mass could not be manually reduced. After completion of concurrent chemoradiotherapy, the tumor mass in the prolapsed uterus decreased and could be reduced manually. Subsequently, the patient underwent hysterectomy and intra-abdominal uterosacral ligament suspension.Outcomes:At 19 months of postoperative follow-up, the patient remained disease-free and had no evidence of vault prolapse.Lessons:This study has important clinical implications and may provide a therapeutic strategy to address unmet medical needs in combination with locally advanced cervical cancer complicated by irreducible complete uterine prolapse. These conditions were successfully treated using a multidisciplinary approach of chemoradiotherapy followed by radical hysterectomy and uterosacral ligament suspension.     

Total uterine prolapse complicated with vesicovaginal fistula: A case report

Rationale:Vesicovaginal fistula (VVF) most commonly occurs due to iatrogenic injury during surgery or obstructed labor. We report a rare case of a patient with severe pelvic organ prolapse who developed VVF even though pessary had not been used.Patient concerns:A 63-year-old postmenopausal woman, para 3 (all spontaneous vaginal deliveries), complained of vaginal bulging sensation and involuntary urinary leakage for 3 years.Diagnosis:Stage IV uterine prolapse with VVF.Interventions:She underwent transvaginal VVF repair combined with total vaginal hysterectomy and sacrospinous ligament fixation. The postoperative course was uncomplicated.Outcomes:The patient remained free of complications during the 1-year follow-up.Lessons:This case illustrates the point that patients with pelvic organ prolapse (POP) should be treated promptly and careful follow-up should be conducted. Clinicians should be aware of the symptoms of VVF to ensure its early diagnosis and treatment.     

腹腔镜盆底和韧带整体修复治疗直肠内脱垂的围手术期加速康复护理的对比研究

目的探讨在盆底整体理论指导下腹腔镜盆底和韧带整体修复手术治疗直肠内脱垂的早期疗效以及加速康复外科围手术期护理方法有效性的对比研究。 方法研究对比2017年3月至2019年11月间行手术治疗82例直肠内脱垂患者的临床资料,40例采用传统围手术期护理（对照组）,42例采用加速康复外科围手术期护理（观察组）。比较两组患者首次排气时间、住院时间、手术出血量、住院费用以及术后并发症的发生率;并且比较两组患者术前和术后3个月直肠脱垂程度（DIRP）、Wexner便秘评分（WCS）、胃肠生活质量指数（GIQLI）及Wexner肛门失禁评分（WIS）。 结果观察组在首次排气时间、住院时间和住院费用明显优于对照组（t=4.991,9.651,10.494;P<0.001）。比较两组术前与术后3个月患者的DIRP、WCS、GIQLI、WIS,结果显示各项指标均得到明显改善（t_对照组=44.826、16.794、9.459、-5.477,t_观察组=44.077、18.504、17.405、-19.730;P<0.001）。观察组术后3个月WCS、GIQLI、WIS与对照组比较均明显改善（t=2.734,11.005,-3.916;P<0.001）,两组术后Clavien-Dindo Ⅰ~Ⅲ级并发症比较差异无统计学意义。 结论在盆底整体理论指导下腹腔镜盆底和韧带整体修复手术治疗直肠内脱垂,创伤小、并发症少、临床效果好。采用加速康复外科围手术期护理措施和方法能够明显加快术后康复速度,早期恢复肠道功能,缩短住院时间,减少住院费用,提高患者生活质量。     

Frequency of anal incontinence and results of pelvic viscerography in 291 women with pelvic organ prolapse

OBJECTIVES: To determine the prevalence of anal incontinence in a population of 291 women with pelvic organ prolapse and evaluate the results of pelvic viscerogram in this situation. MATERIALS AND METHODS: Each patient answered a standardized questionnaire on medical, obstetric and surgical past histories and answers were logged in a database. The viscerograms were performed by a single specialized radiologist. RESULTS: All patients but one were parous. The prevalence of anal incontinence was 26.1%. Stress urinary incontinence and urge urinary incontinence were significantly associated with anal incontinence. No obstetric or surgical risk factor for anal incontinence was demonstrated. Viscerography demonstrated rectoceles (n=86, 29.1%), enteroceles (n=77, 26.5%), cystoceles (n=174, 59.8%), and intra-anal rectal prolapse (n=106, 36.4%). A significant association was found between intra-anal rectal prolapse and anal incontinence. CONCLUSION: Anal incontinence is frequent in patients with pelvic organ prolapse, even more so in the presence of urinary incontinence, and should be investigated by pelvic viscerography. Pelvic floor dysfunction is frequently associated with enteroceles, rectoceles and rectal prolapse. Pelvic viscerograms should be systematically performed in the diagnostic work-up in patients with pelvic organ prolapse when surgical treatment is considered.     

Dynamic pelvic magnetic resonance imaging and cystocolpoproctography alter surgical management of pelvic floor disorders

PURPOSE: Pelvic organ prolapse results in a spectrum of progressively disabling disorders. Despite attempts to standardize the clinical examination, a variety of imaging techniques are used. The purpose of this study was to evaluate dynamic pelvic magnetic resonance imaging and dynamic cystocolpoproctography in the surgical management of females with complex pelvic floor disorders. METHODS: Twenty-two patients were identified from The Johns Hopkins Pelvic Floor Disorders Center database who had symptoms of complex pelvic organ prolapse and underwent dynamic magnetic resonance, dynamic cystocolpoproctography, and subsequent multidisciplinary review and operative repair. RESULTS: The mean age of the study group was 58 ± 13 years, and all patients were Caucasian. Constipation (95.5 percent), urinary incontinence (77.3 percent), complaints of incomplete fecal evacuation (59.1 percent), and bulging vaginal tissues (54.4 percent) were the most common complaints on presentation. All patients had multiple complaints with a median number of 4 symptoms (range, 2–8). Physical examination, dynamic magnetic resonance imaging, and dynamic cystocolpoproctography were concordant for rectocele, enterocele, cystocele, and perineal descent in only 41 percent of patients. Dynamic imaging lead to changes in the initial operative plan in 41 percent of patients. Dynamic magnetic resonance was the only modality that identified levator ani hernias. Dynamic cystocolpoproctography identified sigmoidoceles and internal rectal prolapse more often than physical examination or dynamic magnetic resonance. CONCLUSIONS: Levator ani hernias are often missed by physical examination and traditional fluoroscopic imaging. Dynamic magnetic resonance and cystocolpoproctography are complementary studies to the physical examination that may alter the surgical management of females with complex pelvic floor disorders.Presented at the meeting of The American Society of Colon and Rectal Surgeons, Boston, Massachusetts, June 24 to 29, 2000.No reprints are available.     

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.