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。     

全盆底重建术联合尿道中段悬吊术在盆腔器官脱垂合并压力性尿失禁的作用简

目的 探讨全盆底重建术联合经闭孔阴道无张力尿道中段悬吊术（TVT O）在盆腔器官脱垂（POP）合并压力性尿失禁（SUI）的作用。方法 将78例POP合并SUI患者按照患者家属充分知情自愿原则分为对照组（n=35）与治疗组（n=43）,对照组患者采用无张力尿道中段悬吊术（TVT O）进行保守治疗,治疗组患者采用Prolift 全盆底重建术联合（TVT O）进行治疗,对比两组患者的手术时间、术中出血量、并发症、尿管滞留时间、住院天数及尿动力学、生活质量（I QOL）评分情况。结果 对照组患者的手术时间（112.8±17.9）min、术中出血量（204.8±65.7）mL、尿管滞留时间（2.4±0.5）d、住院天数（5.4±0.6）d 这4个指标均优于观察组［手术时间（152.4±20.9）min、术中出血量（262.5±80.4）mL、尿管滞留时间（2.6±0.5）d、住院天数（5.8±0.7）d］（P均＜005）,但并发症显著高于治疗组（χ 2 =3.864,P=0.049）。治疗组患者的初尿膀胱容量（303.4±26.8）mL、最大膀胱容量（403.1±30.4） mL这2个指标均优于对照组初尿膀胱容量（275.4±19.7）mL、最大膀胱容量（349.8±28.7）mL］（P＜0.05）。术后随访半年的I QOL评分,治疗组与对照组分别为（81.1±12.7）分、（72.9±9.8）分,差异有显著统计学意义（t=4.454,P＜001）。结论 全盆底重建术联合TVT O对POP合并SUI患者疗效确切,拥有更好的近远期疗效,可有效提升患者的生活质量。     

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.     

盆底重建手术患者的临床观察及护理

总结52例改良盆底重建术治疗盆腔脏器脱垂患者的临床观察及护理的经验.术前重点是心理疏导,肠道及阴道准备,术后排尿的观察及盆底肌的训练,对排尿困难、尿潴留、会阴部疼痛及网片侵蚀采取相应的护理措施.结果:术后随访6-8个月52例患者无一例盆腔脏器再脱垂及SUI复发.     

盆底重建术后网片侵蚀致膀胱结石二例

<正>临床资料病例1,61岁,绝经17年,阴道脱出物1个月,诊断为阴道前壁Ⅲ度脱垂,子宫Ⅱ度脱垂,于2014年2月26日行经阴道网片前盆底重建术。因反复尿频尿急尿痛多次复诊,2014年11月25日行经尿道膀胱镜检查+钬激光碎石清石术治疗。术中膀胱内近膀胱三角部位左侧发现有长条状结石(约1. 6×0. 6cm),固定不动,用钬激光击碎结石后,见长约1. 3 cm×0. 3 cm     

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。     

手术治疗女性压力性尿失禁及盆底器官脱垂对患者生活质量的影响

目的：研究手术治疗女性压力性尿失禁（SUI）及盆底器官脱垂（POP）对健康相关生活质量的影响。方法：选择自2001年1月~2007年1月接受TVT、经闭孔无张力吊带术（TVT-O）、前路植入网带及整体植入网带的患者共142例．109例人选并同意参加本研究。采用改良PFDI-20量表评估术前3个月、术后6～12个月及术后12个月以后患者生活质量,采用方差分析对不同性功能变化情况的PFDI-20评分进行比较。结果：PFDI-20总分及POP评分术后较术前显著降低（P〈0．0167）,但术后12个月以后与术后6～12个月相比差异元统计学意义（P〉0．0167）。术后6～12个月时肛直肠症状评分较术前降低,但差异无统计学意义（P;0．0169）。术后12个月以后以术前及术后6～12个月相比均显著改善（P〈0．01671。术后6～12个月及术后12个月以后泌尿系症状较术前显著降低（P〈0．0167）,并且12个月以后较术后6～12个月亦显著改善（P=0．003）．61例术前术后均有性生活。术后6～12个月,20例（37．0％〉术后性功能受损,11例（20．4％）改善．23例（42．6％）无变化;术后12个月以后,21例（34．4％）术后性功能受损,12例（19．7％）改善,28例（45．9％）无变化;术后12个月以后性功能与术后6～12个月相比,无进一步变化;未发现生活质量与性功能之间存在关系。105例（96．3％）患者对手术疗效满意。结论：TVT、TVT-O及经阴道网带治疗SUI及POP疗效显著,术后患者生活质量显著提高。     

改良全盆底重建手术并发症的预防及术后处理措施

盆腔脏器脱垂(POP)是由于盆底肌肉、筋膜等支持组织结构损伤、缺陷等导致盆腔器官位置异常和功能障碍的一类疾病,常发于中老年女性,严重影响患者的生命质量.对于中重度的POP患者,手术仍是最重要且有效的治疗方式.改良全盆底重建术能显著改善患者症状及生活质量,近年来对POP患者的治疗取得了较好的临床效果,但其近、远期并发症也...     

女性盆底手术由泌尿科医生做更好

女性盆底手术由泌尿外科医生还是由妇产科医生来做更好？这个问题问得很好,应该说,由有能力能做好的医生来做。相对而言,泌尿外科医生更有优势,究其原因有如下几点。     

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。     

Mesh Perforation into a Viscus in the Setting of Pelvic Floor Surgery—Presentation and Management

Perforation of a viscus with a mesh product either during or subsequent to pelvic floor reconstruction can be associated with devastating outcomes. If surgeons are going to place mesh, they also need to be familiar with symptoms concerning for perforation. The index of suspicion should always be present, as these patients can present years after initial mesh placement. The best opportunity for intervention in these serious complications is the first intervention. As bits of mesh are chipped away during attempted interventions, residual mesh fragments become disjointed, frayed, and scarred further, making their removal even more challenging, in addition to traumatizing likely already weakened tissues. This review presents strategies for patient evaluation in the setting of possible mesh perforation, in addition to treatment strategies for urethral, bladder, ureteral, and colonic/rectal injury. Ultimately, the decision as to how much mesh is removed should be based on each patient’s unique presentation.     

Female Pelvic Floor Symptoms Before and After Bariatric Surgery

Background

Obesity is a risk factor for female pelvic floor disorders. The study objective was to determine whether there was a difference in the subjective reporting of pelvic symptoms before and after bariatric surgery.

Methods

This was a prospective cohort study of female patients that underwent bariatric surgery. Patients completed a demographic questionnaire, the Pelvic Floor Distress Inventory-20 (PFDI-20), and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7) before surgery and at 6 and 12?months following surgery. Body mass index (BMI) was compared between time points using Student??s t tests (P?P?Results At 12?months after surgery, 63 patients had completed the study. Even with significant weight loss (BMI, 43.7?kg/m² to BMI, 29?kg/m²; P?P?=?0.2). Prevalence of pelvic floor symptom impact on quality of life did significantly decrease after surgery (56% to 30%; P?=?0.004). Baseline PFDI-20 and PFIQ-7 scores were low; however, there was still a significant reduction in PFDI-20 and PFIQ-7 scores after surgery (P?Conclusions Prevalence of pelvic floor symptoms did not vary greatly after surgery; however, significant weight reduction did improve the degree of bother and quality of life related to these symptoms.     

Intraperitoneal Polypropylene Mesh Hernia Repair Complicates Subsequent Abdominal Surgery

Background Prosthetic incisional hernia repair (PIHR) is superior to primary closure in preventing hernia recurrence. Serious complications have been associated with the use of prosthetic material. Complications of subsequent surgical interventions after prior PIHR in relation to its anatomical position were the objectives of this study. Patients and Methods Patients who underwent subsequent laparotomy/laparoscopy after PIHR between January 1992 and February 2005 at our institution were evaluated. Intraperitoneal and preperitoneal mesh was related to complication rates after subsequent surgical interventions. Results Sixty-six of 335 patients underwent re-laparotomy after PIHR. The perioperative course was complicated in 76% (30/39) of procedures with intraperitoneal placed grafts compared to 29% (8/27) of interventions with preperitoneally positioned meshes (P < 0.001). Small bowel resections were necessary in 21% of the intraperitoneal group (8/39) versus 0% in the preperitoneal group. Surgical site infection rates were higher in the intraperitoneal group (10/39, 26%, versus 1/27, 4%). Enterocutaneous fistula formation was rare and occurred in two patients after subsequent laparotomy (5%). Conclusions Re-laparotomy after PIHR with polypropylene meshes are associated with more preoperative and postoperative complications when the mesh is placed intraperitoneally. Therefore 0intraperitoneal positioning of polypropylene mesh at incisional hernia repair should be avoided if possible. J. A. Halm and L. L. de Wall contributed equally to the writing of this article.     

盆底生物反馈治疗前列腺电切术后尿失禁患者的护理干预

目的 探讨盆底生物反馈治疗经尿道前列腺电切术(TURP)后尿失禁的护理方法和效果.方法 对12例TURP术后不同程度尿失禁患者,采用盆底生物反馈电刺激治疗,并实施心理护理、盆底肌肉训练及引导治疗等综合护理.结果 治疗1个疗程后,有效率达83.3%.治疗前患者的腹腔漏尿点压力(ALPP)为(77.50±18.89)cmH2O,治疗后升高至(110.83士11.39)cmH2O,两者比较,差异有显著性意义(P＜0.05).结论 科学的护理干预是盆底生物反馈电刺激治疗TURP术后尿失禁获得良好效果的有力保证.     

Sling Surgery for Female Incontinence

The pelvic floor is at an increased risk of damage during the lifespan of women. Pregnancy, vaginal delivery, aging, menopause, previous pelvic surgery, and lifestyle factors have a negative influence on the connective tissue and muscular components of the pelvic floor leading to urinary incontinence (UI). Pregnancy and vaginal delivery have been identified as the most important risk factors for incontinence. Cystocele, rectocele, uterine, vault prolapse, and/or incontinence can occur due to lacerations of the connective tissue support at different levels. Moreover, muscular damage of the levator complex can lead to widening of the levator hiatus, giving way to the descent of pelvic organs resulting in UI. Although some genetic abnormalities have been identified, their clinical implications remain unclear. Diagnostic evaluations should be performed in accordance with established evidence-based guidelines. Although short-term results of single-incision midurethral slings indicate similar efficacy to conventional midurethral slings, their long-term outcome is still not determined. Scientists continue to investigate the exact causes of stress UI as well as the optimum substitute material using the best surgical reconstructive approach. The recent European Association of Urology consensus statement underlines an imperative requirement for an optimal solution using minimal amount of material related to the indication and higher competence of surgeons for this surgery. High-quality trials with a longer follow-up are currently an unmet need.     

小气囊扩张术加肉毒毒素A注射治疗贲门失弛症患者的护理

对41例贲门失弛症患者,在内镜下行小气囊扩张术加肉毒毒素A食管下段括约肌注射治疗,术前加强心理护理,术中密切配合,术后严密监测生命指征.结果41例AC患者治疗当日症状明显缓解,无并发症发生;随访1年发现,3个月复发1例(2.44%);6个月复发2例(4.88%),1年复发5例(12.20%).提出内镜下行小气囊扩张加注射肉毒毒素A治疗贲门失弛症安全、经济、简便易行,近期效果良好;加强围术期护理至关重要.     

基于微信平台的延续性护理对盆底手术患者切口瘢痕的影响

目的 分析基于微信平台的延续性护理对盆底手术患者切口瘢痕影响。方法 选择2022年7月- 2023年12月于本院接受盆底手术的120例患者为研究对象,按照随机数字表法分为对照组（n =60）与观 察组（n =60）。对照组实施围术期护理,观察组在对照组基础上实施基于微信平台的延续性护理,比 较两组切口愈合情况、瘢痕淡化情况及生活质量。结果 观察组甲级愈合率为96.67%,优于对照组的 75.00%（P ＜0.05）;观察组VSS、PSAS评分低于对照组（P ＜0.05）;观察组干预后生活质量评分高于 对照组（P＜0.05）。结论 对盆底手术患者实施基于微信平台的延续性护理可加快其切口愈合,淡化瘢痕 组织,提升其术后生活质量。