经阴道网片盆底重建术治疗盆底脏器脱垂患者临床疗效

目的探讨经阴道网片盆底重建术治疗盆底脏器脱垂（pelvic organ prolapse,POP）患者的临床效果观察及安全性疗效。 方法选取2016年1月至2017年12月,河北省邯郸市中心医院118例POP患者的临床资料,按照术式不同分为2组,每组患者59例。对照组采用传统的手术方式进行治疗,试验组采用经阴道网片盆底重建术进行治疗。 结果试验组手术时间、术后首次下床活动及住院时间均短于对照组,差异有统计学意义（P<0.05）。试验组术中出血量与对照组比较比较,差异无统计学意义（P>0.05）。试验组术后有效率明显高于对照组,差异有统计学意义（P<0.05）。 结论经阴道网片盆底重建术是治疗POP患者有效、安全的术式,可显著改善患者的临床症状,但需严格按照手术适应症进行。     

盆底修补术后聚丙烯网片阴道暴露的组织学观察

目的：探讨使用聚丙烯网片行盆底修补术后发生网片暴露的局部组织病理学变化.方法：2004年5月-2011年12月于解放军总医院第一附属医院妇产科采用聚丙烯网片经阴道盆底修补治疗盆底功能障碍并于术后发生网片阴道暴露的患者18例,对局部暴露的网片进行切除,采用光镜和扫描电镜观察局部的组织学变化和暴露网片的变化.结果：经阴道网片盆底重建术后12个月发生网片暴露18例,其中临床阴道检查中可见明显感染者5例,仅见纤维结缔组织增生者13例.对18例阴道局部切除的网片进行光镜观察后发现,16例可见网片周围结缔组织中有白细胞或巨噬细胞浸润,另2例未见白细胞浸润.扫描电镜检查发现18例中12例暴露的网片存在明显聚丙烯纤维丝表面降解和横向断裂现象.结论：阴道组织内网片周围炎症反应引起的纤维生物降解可能是导致阴道植入网片发生暴露的原因之一.     

盆底重建术治疗盆腔器官脱垂临床疗效观察

目的研究盆底重建术治疗盆腔器官脱垂的临床效果。方法将盆腔器官脱垂患者100例随机分为实验组和对照组,各50例。实验组应用网片进行全盆底重建术治疗,对照组应用阴式全子宫切除及阴道前后壁修补术治疗。收集两组患者年龄、发病年限、绝经年龄、体质量指数、分娩次数等一般资料及手术时间、术中出血量、留置尿管时间、平均住院时间和术后1、3、6、12个月满意程度的调查数据,进行统计学分析。结果两组患者年龄、发病年限、绝经年龄、体质量指数、分娩次数等一般资料数据比较,差异无统计学意义(P0.05)。两组患者手术时间、术中出血量、留置尿管时间、平均住院时间和术后1、3、6、12个月满意程度的调查数据比较,差异具有统计学意义(P0.05)。结论应用网片治疗的全盆底重建术对于恢复女性盆腔器官脱垂,效果明显,术后满意度高,效果肯定。     

经阴道网片添加的前盆重建术在膀胱膨出治疗中的应用

目的总结经阴道网片添加的前盆重建术在膀胱膨出治疗中的应用体会。 方法回顾性分析自2017年1月至2018年4月我院12例膀胱膨出患者的临床资料。12例患者经术前体格检查,诊断明确。所有患者实施经阴道添加网片的前盆修复手术。 结果12例患者均手术顺利,平均手术时间65 min,平均手术出血量20 ml。术后拔除导尿管均排尿通畅。随访3~16个月无复发,无网片暴露等并发症发生。 结论经阴道网片添加的前盆重建术在膀胱膨出患者中的治疗效果良好,掌握手术技巧可以提高手术的成功率,减少并发症的发生,值得临床推广应用。     

网片添加的盆底重建手术的相关并发症

女性盆底功能障碍性疾病（pelvicfloordysfunction,PFD）,又称为盆底缺陷（pelvicfloordefects）或盆底支持组织松弛（relaxation of pelvic supports）,严重影响中老年女性的生活质量。采用手术治疗女性盆底功能障碍疾病已相当普遍[1],大约有11％的女性在一生中需要经历脱垂手术治疗,其中大约有30％的患者在首次手术后4年中需要再次手术治疗[2]。PFD不是一种威胁生命的疾病,但由于疾病导致的解剖异常,进而发生功能障碍,引起例如子宫脱垂、阴道前后壁膨出、尿失禁、排尿困难、大便失禁等症状,会降低患者的生活质量[3]。     

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。     

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.     

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。     

46例盆腔器官脱垂Prolift全盆底重建术的护理

目的:通过Prolift全盆底重建术对46例盆腔器官脱垂的患者进行手术治疗和护理,使盆底器官脱垂得到有效的治愈.方法:对采用Prolift全盆底重建术的患者术前进行心理护理和术后动态观察治疗,做好术后并发症的观察以及术后指导.结果:采取有效的手术和精心的护理治疗46例盆腔器官脱垂的患者全部康复出院.结论:通过有效的护理提高Prolift全盆底重建术对盆腔器官脱垂的患者进行手术治疗成功率.     

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。     

Complications of transvaginal monofilament polypropylene mesh in pelvic organ prolapse repair

Introduction and hypothesis  This study aimed to document intraoperative and postoperative complications associated with the use of transvaginal polypropylene mesh in the repair of pelvic organ prolapse (POP). Methods  This is a retrospective review of 127 cases of transvaginal repair of POP using synthetic mesh. Results  Mean postoperative value (±SD) for pelvic organ prolapse quantification (POPQ) measurements Aa, Ap, and C were: −2.4 ± 1.1 (cm), −2.4 ± 0.9 (cm), and −7.7 ± 1.2 (cm), respectively. The difference between preoperative and postoperative values of these points was significant (p < 0.0001). Mesh erosion rate was 13/127 (10.2%) with significant correlation between mesh erosion and concurrent vaginal hysterectomy (p = 0.008). Combined anterior and posterior vaginal mesh surgery increased the risk of intraoperative bleeding and blood transfusion (p < 0.05). Conclusions  Concurrent vaginal hysterectomy is associated with increased risk of vaginal mesh erosion. Combined anterior and posterior vaginal mesh repair is an increased risk factor for intraoperative bleeding and blood transfusion.     

Quality of life after surgery for genital prolapse in elderly women: obliterative and reconstructive surgery

The objective of this study was to determine if obliterative and reconstructive vaginal surgery for advanced pelvic organ prolapse improve quality of life in elderly women. Women age 65 years or older with stage 3 or 4 pelvic organ prolapse who desired surgical correction were prospectively enrolled. The subjects underwent either obliterative or reconstructive vaginal surgery based on their personal preference and sexual expectations. The subjects received a pelvic organ prolapse quantitation examination and completed the pelvic floor distress inventory (PFDI), the pelvic floor impact questionnaire (PFIQ), the SF-36, and the Beck depression inventory preoperatively, 6 and 12 months after surgery. Seventy-nine subjects were enrolled, 70 of whom completed follow-up: 30 in the obliterative group and 40 in the reconstructive group. Both groups demonstrated significant improvements in the pelvic organ prolapse, urinary, and colorectal scales of the PFDI and PFIQ 6 and 12 months after surgery with no differences between the two treatment groups. In addition, there were significant and clinically important improvements noted in the bodily pain, vitality, social functioning, role–emotional, and mental health summary scales of the SF-36 in both groups after surgery, with no significant difference between groups. In appropriately selected elderly women, both obliterative and reconstructive vaginal surgery for advanced pelvic organ prolapse significantly improved health-related quality of life.     

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...     

Dyspareunia and chronic pelvic pain after polypropylene mesh augmentation for transvaginal repair of anterior vaginal wall prolapse

Synthetic mesh augmentations for pelvic floor reconstructive surgeries are increasing in usage and popularity. Many studies are focusing on the anatomical success rates of transvaginal anterior compartment repairs with synthetic mesh, with minimal attention on its postoperative complications. We present a case report on a 59-year-old postmenopausal woman who underwent an anterior repair with 6×4-cm polypropylene mesh. Postoperatively, she developed severe dyspareunia and debilitating chronic pelvic pain. The patient failed conservative medical therapy and now requests complete removal of the synthetic mesh. No financial support or corporate sponsorship was obtained for this project.     

Symptomatic and quality of life outcomes after site-specific fascial reattachment for pelvic organ prolapse repair

The aim of this study was to assess symptomatic and quality of life outcome scores following site specific fascial reattachment surgery for pelvic organ prolapse using the validated Prolapse Quality of Life (P-QOL) questionnaires. One hundred and ninety two women underwent surgery for pelvic organ prolapse; ninety four underwent anterior repair (thirty four of them had vaginal hysterectomy), and ninety eight had posterior repair. Patients filled P-QOL questionnaires 24 hours prior to surgery and a postal P-QOL questionnaire six months post operatively. Pre and post operative questionnaires were paired. Quality of life and symptoms scores were calculated using Wilcoxon signed rank test. One hundred and one women returned their questionnaires and were suitable to include in the study. Forty nine underwent anterior repair (fifteen had vaginal hysterectomy) and 52 underwent posterior repair. Quality of life scores showed significant improvement in the anterior and posterior repair groups with the exception of general health in the anterior repair group and general health and prolapse impact in the posterior repair group. Anterior repair significantly improved urinary voiding and storage symptoms. Posterior repair group showed significant improvement in defecatory symptoms. Both groups showed improvement in sexual function and general prolapse symptoms. Prolapse repair with site specific fascial reattachment results in significant improvement in quality of life scores six months after surgery. Anterior repair improves urinary voiding and storage symptoms and posterior repair improves defecatory dysfunction and urinary voiding. Sexual function improves following prolapse repair with site specific fascial reattachment. Presentation information: British Society of Urogynaecology Annual Scientific Meeting, Royal College of Obstetricians and Gynaecologists, London, UK. November 17th 2006.     

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 randomized trial of local anesthesia with intravenous sedation vs general anesthesia for the vaginal correction of pelvic organ prolapse

The purpose of this study is to compare the feasibility of local anesthesia with IV sedation versus general anesthesia for vaginal correction of pelvic organ prolapse. Patients with pelvic organ prolapse who were scheduled for an anterior or posterior colporrhaphy, or an obliterative procedure, and who did not have a contraindication or preference to type of anesthesia were randomized to one of the two anesthesia groups. Nineteen patients were randomized to the general group and 21 patients were randomized to the local group. Mean operating room, anesthesia, and surgical time were similar in each group, and 10 patients in the local group bypassed the recovery room. Requests and doses of antiemetics, postoperative verbal numerical pain scores and length of hospital stay were similar between the two groups. Mean recovery room and total hospital costs were significantly lower in the local group. Local anesthesia with IV sedation is a feasible alternative for vaginal surgery to correct pelvic organ prolapse.