腹腔镜下髂耻韧带固定术在盆腔器官脱垂治疗的短期疗效

目的 分析腹腔镜下髂耻韧带固定术在盆腔器官脱垂治疗的短期疗效。方法 回顾性分析2020年3月至2022年6月在本院因盆腔器官脱垂而收入本院的患者46例的临床资料，按照患者接受的手术方式将其分为对照组和观察组各23例，对照组患者接受腹腔镜下骶骨固定术，观察组患者接受腹腔镜下髂耻韧带固定术。比较两组患者的手术指标、术前术后盆底功能状况和并发症情况。结果 观察两组患者的手术指标，对照组患者的手术时间和出血量均高于观察组患者，差异具备统计学意义（P<0.05）；两组患者的住院时间比较差异不显著，P>0.05。两组患者术前及术后盆底功能的比较，术前的盆底障碍影响简易问卷7(pelvic floor impact questionnaire-short form-7,PFIQ-7)和盆底功能障碍问卷（pelvic floor distress inventory-short form 20,PFDI-20）评分差异比较不具备统计学差异，P>0.05；两组患者术后的PFIQ-7和PFDI-20评分差异比较，观察组均优于对照组，差异具备统计学意义，P<0.05。两组患者术后的并...     

单孔腹腔镜与阴式骶棘韧带悬吊术治疗盆腔器官脱垂效果分析

目的探讨单孔腹腔镜入路和阴式入路骶棘韧带悬吊术(sacrospinous ligament fixation, SSLF)治疗盆腔器官脱垂(pelvic organ prolapse, POP)的安全性和有效性。 方法回顾性分析2017年1月至2018年12月武汉大学中南医院妇产科收治的47例POP的患者，其中21例行单孔腹腔镜SSLF(单孔腹腔镜组)、26例行阴式SSLF(阴式组)。分析患者的手术时间、术中出血量、住院时间、术后通气时间、临床不良反应发生率(包括术中出血、术后阴道出血、术后排尿困难、漏尿、尿潴留等)、POP－Q(盆腔器官脱垂定量分期法)各指示点测量指标、PFIQ－7(盆底障碍影响简易问卷)、PISQ－12(盆腔脏器脱垂/尿失禁性功能问卷)及患者的复发情况。 结果单孔腹腔镜入路与阴式入路的术中出血量、住院时间、临床不良反应率比较，差异具有统计学意义(P<0.05)；两组的手术时间、术后通气时间比较，差异无统计学意义(P>0.05)；两组的术前和术后POP－Q各指示点测量值、PFIQ－7、PISQ－12都有明显的改善，但两组间差值比较，差异无有统计学意义(P>0.05)；术后随访1年，两组均无复发患者。 结论单孔腹腔镜SSLF对于POP的治疗具有一定的安全性和有效性，可以在临床上推广。     

腹腔镜下子宫悬吊术治疗盆腔器官脱垂对患者生活质量的影响

目的 研究盆腔器官脱垂患者应用腹腔镜下子宫悬吊术对生活质量的影响。方法 回顾性分析2019年1月至2021年6月本院收治的104例盆腔器官脱垂患者，依据患者是否保留子宫意愿将其分为甲组（56例）、乙组（48例），其中甲组接受腹腔镜子宫悬吊术（LUS），乙组接受阴式全子宫切除术+骶韧带悬吊术。比较两组的手术效果、生活质量、并发症、复发率、再手术率。结果 经分析，两组治疗后的盆腔器官脱垂度分级、拔除尿管时间、并发症发生率、1年内再手术率相比无差异（P>0.05）；相比于乙组，甲组术中出血量少，手术用时及住院时间短，1年内复发率低（P<0.05）；治疗后，相比于乙组，甲组的盆底功能障碍问卷（PFDI-20）、全身状况改善问卷（PGI-I）、盆底障碍影响简易问卷-7(PFIQ-7)评分低，盆腔脏器脱垂/尿失禁性功能问卷（PISQ-12）评分高（P<0.05）。结论 LUS相比于阴式子宫全切术明显改善了手术效果，提高了生活质量，且1年内的复发率低，对于有保留子宫意愿的患者属于更优的选择。     

腹腔镜腹股沟韧带悬吊术与腹腔镜骶骨固定术治疗重度盆腔器官脱垂的疗效分析

目的:探讨腹腔镜腹股沟韧带悬吊术(LILS)与腹腔镜骶骨固定术(LSC)治疗重度盆底器官脱垂(POP)的临床疗效.方法:回顾分析2016年1月至2018年12月因重度POP行LILS的42例患者(LILS组)与行LSC的46例患者(LSC组)的临床资料,对比分析两组手术时间、术中出血量、术中与术后并发症及术前、术后1年...     

腹腔镜下圆韧带悬吊术治疗子宫脱垂的临床疗效

目的 分析腹腔镜下圆韧带悬吊术治疗子宫脱垂的临床疗效。方法 收集2019年3月至2021年12月期间在本院就诊的子宫脱垂患者62例的临床资料，根据患者接受手术方式的不同分为对照组（采取阴式子宫切除）和实验组（采取阴道残端高位骶韧带联合圆韧带悬吊术）各31例。观察患者的术中出血量，手术持续时间，住院时间和住院费用。观察患者的术前和术后的术前PFIQ-7评分，术后的子宫脱垂的复发情况和术后的复发时间。观察患者术后的并发症发生情况。结果 两组患者在术中出血量、手术持续时间和住院费用比较中没有差异，P>0.05；而实验组患者的住院时间显著低于对照组，差异有统计学意义，P<0.05。实验组患者在随访期内有4例复发，术后复发间隔时间为10±2.22月，两组患者在术前PFIQ-7评分比较中没有差异性，P>0.05；而术后PFIQ-7评分实验组显著低于对照组，差异有统计学意义，P<0.05。两组患者术后的总并发症发生情况比较，实验组患者的并发症发生情况显著低于对照组，差异有统计学意义，P<0.05。结论 腹腔镜圆韧带悬吊术治疗子宫脱垂能够复位患者的盆底器官的毗邻关系，提升...     

腹腔镜高位骶韧带悬吊联合传统术式治疗育龄女性盆腔器官脱垂17例分析北大核心CSCD

目的探讨腹腔镜高位骶韧带悬吊(high uterosacral ligament suspension,HUS)联合传统术式(宫颈部分切除、阴道壁修补、会阴修补等)治疗育龄女性盆腔器官脱垂(pelvic organ prolapse,POP)的效果及安全性。方法回顾性分析2016年5月~2021年5月育龄POP患者17例的临床资料,行腹腔镜HUS同时行宫颈部分切除15例,阴道前壁修补12例,阴道后壁修补4例,会阴修补14例。结果17例手术时间(95.8±15.7)min,出血量20~50 ml,住院时间6~8 d。17例随访6~69个月,(39.3±20.6)月。客观成功率94%(16/17),主观成功率100%(17/17)。PGI-I评分非常好13例,很好3例,有些好1例。性生活明显改善13例,改善3例,无变化1例。术后妊娠2例,其中1例已剖宫产分娩。结论腹腔镜HUS联合有效的传统术式治疗有手术指征的育龄女性POP安全,微创,规避植入材料的使用,术式简单易掌握,常规器械即可完成。     

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。     

改良腹腔镜子宫悬吊术治疗子宫脱垂20例报告

目的:探讨改良腹腔镜子宫悬吊术的临床效果。方法:回顾分析2012年6月至2013年7月为20例子宫脱垂患者行改良腹腔镜子宫悬吊术的临床资料。记录患者术后2、6、12个月的后期疗效。结果:20例患者均成功完成手术,手术时间60~135 min,平均(98±25)min;术中出血量30~80 ml,平均(65±12)ml;术后患者使用导尿管的时间平均(3.0±1.5)d;术后住院4~6 d,平均(4.5±0.5)d。术后患者盆底康复情况良好,性生活均得到明显改善。术后2~12个月子宫均恢复至正常位置,无脱垂现象。结论:改良腹腔镜子宫悬吊术安全、疗效确切、花费低、创伤小、术后疼痛轻、住院时间短、术后康复快,保留了子宫,且更好地保留了阴道功能,值得推广应用。     

腹腔镜阴道骶骨固定术治疗女性盆腔器官脱垂的40例分析

目的探讨腹腔镜阴道骶骨固定术(laparoscopic sacrocolpopexy，LSC)治疗女性盆腔器官脱垂(pelvic organ prolapse，POP)的可行性和临床疗效。 方法选取首都医科大学附属北京安贞医院2015年1月至2017年12月因POP进行子宫切除并LSC治疗患者40例，采用POP-Q分期法和盆底功能障碍问卷表(PFDI-20)、盆底功能影响问卷表(PFIQ-7)、性功能调查问卷评分(PISQ-31)评价解剖及功能疗效。患者年龄45～77岁，平均(60.8±1.4)岁；孕1～4次，平均(2.8±0.7)次；产1～3次，平均(1.7±0.5)次。 结果手术时间130～330 min，平均(215.2±7.6)min；术中出血量20～300 ml，平均(82.3±9.2)ml；术后住院时间3～19 d，平均(6.6±0.4)d；术后阴道长度7.0～8.5 cm，平均7.5 cm；术后例随访8～21个月，平均11个月；术后客观无脱垂复发，客观治愈率为100%，术后自觉症状较术前改善，正常恢复性生活，主观满意度100%。 结论LSC在女性盆腔器官脱垂的治疗中客观治愈率高，术后性生活满意，有一定的临床疗效。     

Optimizing pelvic organ prolapse research

For many years, researchers on this field have suffered from the lack of an efficient method for describing pelvic organ prolapse. Struggling to solve this problem, the International Continence Society has proposed a pelvic organ prolapse quantification (POP-Q) system [Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P, Shull B, Smith ARB, Am J Obstet Gynecol, 175(1):1956-1962, 1996], which was validated as a precise and reproducible technique for describing pelvic organ position. However, even though very precise at describing pelvic organ position, our critic to this system is its limited ability to quantify the prolapse itself, since it still classifies prolapse into four grades, almost the same way as Baden and Walker did in 1972. As a result, the same grade can include a wide prolapse intensity range. The objective of this paper is to propose a method that makes POP research more efficient by directly measuring prolapse as a continuous variable that requires lesser number of subjects in order to achieve statistical significance.     

Validation of the pelvic organ prolapse quantification (POP-Q) system in left lateral position

Introduction and hypothesis  The purpose of this study is to examine the inter-observer reliability of the pelvic organ prolapse quantification (POP-Q) system in left lateral position. Methods  Women attending urogynaecology outpatient clinics were examined in the left lateral position using a digital examination and POP-Q. This was repeated separately by a second blinded clinician. The inter-observer agreement was calculated using the Cohen’s kappa coefficient. The POP-Q examination was then performed with a woman lying in dorsal lithotomy position. The POP-Q findings in the two positions were compared. Results  Two hundred and eighteen women were recruited. The digital examination had a moderate inter-observer reliability with a kappa value of 0.54. The POP-Q showed a high degree of reliability (0.88). There was a high degree of correlation between the POP-Q findings in left lateral and lithotomy position (rho > 0.95, p < 0.001). Conclusion  The POP-Q in the left lateral position is reliable, easy to perform, acceptable for patients, and is not a time-consuming examination.     

超声评估盆腔脏器脱垂患者盆底结构的研究进展

目的盆腔器官脱垂(POP)显著影响女性生活质量。本文对比三维超声新技术与其他成像技术,对经二维、三维超声成像技术获取的信息及超声观察POP患者的盆底结构的研究进展进行综述。     

Self-perceived natural history of pelvic organ prolapse described by women presenting for treatment

Introduction and hypothesis  This study aimed to describe the self-perceived natural history of pelvic organ prolapse (POP) in women seeking care. Methods  Women presenting to a university-based urogynecology clinic for POP (n = 107) completed a questionnaire including questions about how and when their prolapse was discovered. A urogynecologic examination including the pelvic organ prolapse quantification (POP-Q) was also performed. Results  Forty-eight percent of these women sought medical attention “immediately” after discovering a bulge. The median time to seek care was 4 months (range from 1 month to 45 years). Twenty-six percent associated their prolapse with a specific event (e.g., moving furniture or pushing a car). POP was self-discovered by 76% (81/107) of women. Self-discovered prolapses were larger than those diagnosed by physicians (Ba +1.3 vs 0.1 cm, P = .03, respectively). Conclusions  Women seek medical advice within months of discovering their prolapse. Self-discovery is associated with higher stage prolapse than prolapse diagnosed by health care providers.     

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。     

超声评估盆腔器官脱垂的进展

超声可清晰显示盆底解剖结构、盆底重建术后网片位置及长度,且诊断重度盆腔器官脱垂与盆腔器官脱垂定量分度标准的一致性较好,可为评价盆底重建术的安全性及有效性提供影像学基础。本文对超声在盆腔器官脱垂诊断及盆底重建术术后疗效评价中的应用进展进行综述。     

The development of pelvic organ prolapse following isolated Burch retropubic urethropexy

The purpose of our study was to examine the incidence of prolapse in a group of women who had had an isolated Tanagho modification of the Burch colposuspension performed without significant pelvic organ prolapse preoperatively. Sixty women were identified who underwent an isolated Burch procedure for genuine stress incontinence between 1991 and 1999. Thirty-four women returned for postoperative Pelvic Organ Prolapse Quantification (POP-Q) staging evaluation. Overall, 6 (17.6%) had stage II anterior prolapse. Eleven (32.4%) had stage II posterior prolapse. Three (8.8%) had stage II uterine prolapse. None of these patients with identified support defects was symptomatic. Two patients had subsequently undergone vaginal hysterectomy. One had this performed for dysfunctional uterine bleeding 3 years after her Burch procedure. One patient developed symptomatic uterine prolapse and underwent a vaginal hysterectomy 5 months after her Burch procedure. The majority of patients undergoing an isolated Tanagho modification Burch procedure without preoperative prolapse do not appear to be placed at increased risk for subsequent operative intervention.     

Acute pelvic organ prolapse in an 11-month-old infant

There exist several reports of pelvic organ prolapse in high-risk neonates, but acute pelvic organ prolapse in a healthy infant has never been reported. In the current case, the parents first noted their 11-month-old infant with a mass protruding from the vagina after playing in a baby walker. Third-degree uterine prolapse was subsequently diagnosed after careful physical examination and pelvic ultrasonography. Under general anesthesia, the uterus was replaced after emptying the bladder. No sequelae were noted during 6 months of follow-up.An erratum to this article can be found at