女性盆腔器官脱垂的影响因素

目的探讨女性盆腔器官脱垂(POP)发病的相关因素对生活质量的影响。方法于2009年1～8月随机调查在长春市某医院妇产科门诊就诊及住院病人的POP发病情况、绝经情况、生育史、排尿异常状况、生活质量等项目;对获得的583例调查者的有效资料进行统计分析。结果 POP主要发生在45岁以上妇女,特别是绝经5年以上者,表现出随着年龄增加,POP发病率逐步升高的趋势。POP的患病率随分娩次数增加而显著升高(P<0.01)。64.9%的POP患者同时伴有排尿异常,远高于非POP者(20.8%)(P<0.01)。POP患者感到对性生活和日常生活有影响,只有22.7%POP患者就诊过,64.9%的患者未经过治疗。结论患者年龄越大、绝经时间越久,女性POP发病率越高;妇女多次妊娠和分娩增加了POP发病率。POP常常伴随着排尿异常,且大多数患者认识不足。应针对影响因素进行有针对性的预防,做好疾病知识、计划生育工作的宣传,指导妇女进行缩肛锻炼,提高盆底组织的支持力。     

盆腔重建Prolift手术对老年女性重度盆腔器官脱垂的临床疗效

<正>盆腔器官脱垂(POP)是由多种原因导致的盆底肌肉、韧带支持薄弱,引起盆腔脏器移位,连锁引发其他盆腔器官的位置和功能异常。随着人类寿命延长和老龄化加速,POP发病率呈上升趋势,严重影响中老年女性身体健康和生活质量〔1³〕。目前,手术是治疗中重度POP的重要方法之一,但传统手术术后患者复发率较高〔4〕。因此,本研究通过观察Prolift盆腔重建术治疗老年女性POP的临床疗效,为临床治疗提高参考。     

老年女性盆腔器官脱垂的治疗进展

盆腔脏器脱垂指机体盆底肌肉、骨骼支持系统作用逐渐减弱,导致盆腔内直肠、子宫和膀胱等器官组织位置出现下移的一种疾病[1].其中女性盆腔脏器脱垂(pelvic organ prolapse,POP)作为常见类型之一,指盆腔器官在各种因素影响下导致盆底功能支持薄弱,进而造成盆腔脏器移位,从而自然脱出阴道外.     

重庆市高龄女性盆腔器官脱垂的危险因素

目的探讨重庆市高龄女性盆腔器官脱垂的危险因素。方法对就诊的盆腔器官脱垂资料进行调查分析。采用该院妇产科医师设计的调查表,对患者进行询问调查。包括患者人口学特征、生育情况、既往病史、慢性疾病史等。结果体重指数(BMI)24、产次、慢性咳嗽、便秘、盆腔手术史是引发盆腔器官脱垂的危险因素。结论文化程度、BMI值、分娩次数、便秘、慢性咳嗽、患有慢性盆腔炎、有盆腔手术史是导致高龄女性盆腔脱垂的危险因素,临床对盆腔器官脱垂的危险因素进行研究分析,对预防及控制盆腔器官脱垂有积极意义。     

盆底三维超声在老年女性盆腔器官脱垂诊断中的应用

目的 观察老年女性盆腔器官脱垂时三维超声检查时各参数水平,分析盆底三维超声在老年女性盆腔器官脱垂中的诊断价值.方法 回顾分析2017年4月至2019年4月确诊的100例老年盆腔器官脱垂女性患者的病历资料为观察组,另选取同时期来院就诊并确诊为其他非盆腔器官脱垂85例为对照组,全部患者接受盆底三维超声检查,比较两组超声检查...     

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。     

应用全盆底重建术治疗老年女性重度盆腔器官脱垂临床分析

目的 评价全盆底重建术治疗老年女性重度盆腔器官脱垂的疗效.方法 回顾性分析34例POP-QⅢ～Ⅳ期盆腔器官脱垂行全盆底重建术的老年患者临床资料,评价该手术疗效及对患者生活质量的影响.结果 所有手术均安全顺利进行,未见膀胱、直肠等损伤;手术时间（105±31.2） min,出血（185.4±65.9） mL;所有患者术后4～5d后均自主排尿.随访2年,复发率为0（0/34）;PFIQ评分由术前的（84.3±22.6）分降至术后2年的（11.2±6.5）分,PFDI评分由术前的（75.8±19.4）分降至术后2年的（12.4±5.3）分.结论 全盆底重建术用于纠正老年女性重度盆腔器官脱垂,手术安全,术后生活质量改善明显,值得临床推广应用.     

盆腔器官脱垂的老年女性肛提肌三维超声断层成像特点

目的应用三维超声断层成像(TUI)技术观察老年女性在静息、最大Valsalva和缩肛时的肛提肌形态,评估女性盆腔器官脱垂(POP)与肛提肌-尿道间隙(LUG)的关系。方法 51例老年女性(26例POP组,25例对照组),经阴道三维超声检查,采集盆底三维容积数据,启用TUI分析。观察肛提肌在静息、最大Valsalva和缩肛时的形态改变并测量LUG。结果 TUI技术可在多个连续的平行平面上显示肛提肌的形态,POP组静息、最大Valsalva及缩肛状态下的LUG较对照组大(P<0.01)。结论 TUI成像可在连续断层的切面上清晰显示耻骨直肠肌的形态,LUG可作为评价盆腔器官脱垂的重要指标。     

阴道全封闭术治疗老年女性盆腔器官脱垂的疗效

目的 分析老年女性盆腔器官脱垂(POP)患者实施阴道全封闭术的临床疗效及安全性.方法 选取2012年1月至2018年1月在佛山市妇幼保健院妇科住院治疗、盆腔器官脱垂分期法(POP-Q)评定为Ⅲ～Ⅳ期、并接受阴道全封闭术治疗的78例老年POP患者.所有患者治疗后进行1年随访观察,记录术前和术后POP-Q分期情况.分析患者...     

改良盆底重建术治疗盆腔脏器脱垂疗效观察

目的观察改良盆底重建术治疗盆腔脏器脱垂的疗效。方法50例盆腔器官脱垂患者,随机分为对照组和观察组各25例。对照组采用传统盆底重建术,观察组行改良盆底重建术。结果两组患者手术顺利。观察组阴道前壁脱垂全部得到纠正;随访1a均未出现复发;未见手术并发症。对照组6例复发,2例发生尿潴留,2例阴道聚丙烯补片修补术后发生侵蚀。观察组保留尿管时间和平均住院天数均明显少于对照组（P均〈0．05）。结论改良盆底重建术治疗盆腔脏器脱垂安全有效。     

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.     

Management of recto-vaginal fistulas after prosthetic reinforcement treatment for pelvic organ prolapse

AIM: To communicate our findings on successful treat-ment of recto-vaginal fistulas (RVFs) after prosthetic reinforcement surgery of pelvic organ prolapse (POP). METHODS: A retrospective single center study between 1998 and 2008 was performed. A total of 80 patients with RVF were identified, of which five patients (6%), with a mean age of 65 years (range: 52-73), had undergone previous surgery for POP with pros-thetic reinforcement. RESULTS: All patients complained about ongoing vaginal infections and febri...     

Perineal descent and levator ani hernia: a dynamic magnetic resonance imaging study

PURPOSE: Patients with symptomatic pelvic organ prolapse often have multifocal pelvic floor defects that are not always evident of physical examination. In this study, dynamic magnetic resonance imaging of symptomatic patients with pelvic floor prolapse demonstrated unsuspected levator ani hernia. This study was designed to identify any specific symptoms and/or physical findings associated with these hernias.METHODS: Eighty consecutive patients with pelvic organ prolapse, fecal and/or urinary incontinence, or chronic constipation received standardized questionnaires, physical examination, and dynamic magnetic resonance imaging. Fishers exact test was used to compare symptoms and examination findings between patients with or without levator ani hernia.RESULTS: Twelve patients (15 percent) were found to have unilateral (n = 8) or bilateral (n = 4) levator ani hernias on dynamic magnetic resonance imaging. No one specific symptom was directly associated with the presence of a levator ani hernia. Furthermore, levator ani hernias were not found more frequently in patients with previous pelvic floor surgery. Perineal descent on physical examination was associated with the finding of a levator ani hernia in nine patients (P = 0.02). Although not statistically significant, there was a trend toward a lower incidence of levator ani hernia in females using estrogen replacement therapy (P = 0.06).CONCLUSIONS: Patients with symptomatic pelvic organ prolapse and perineal descent on physical examination may have a levator ani hernia. Although the significance of levator ani hernia needs to be determined, the recurrence rate after the surgical management of pelvic organ prolapse remains unacceptably high, and ongoing investigation of all associated abnormalities is warranted.Data were obtained from the Johns Hopkins Pelvic Floor Database. Poster presentation at The American Society of Colon and Rectal Surgery Meeting, Boston, Massachusetts, June 24 to 29, 2000.     

中老年女性盆腔器官脱垂患者尿动力学检查106例临床分析

目的探讨女性盆腔脏器脱垂（pelvic organ prolapse,POP）的尿动力学特点,了解盆腔脏器脱垂与压力性尿失禁（stress urinary incontinence,SUI）的关系。方法对2006年1月至2009年12月在本院就诊的106例女性盆腔脏器脱垂患者,采用盆腔脏器脱垂评估分类法（pelvic organ prolapse quantitative examination,POP-Q）评估,并进行尿动力学检查,测定尿动力学参数,对结果进行统计学分析。结果 106例盆腔脏器脱垂患者中,合并SUI 76例（Ⅰ型SUI 36例,Ⅱ型24例,Ⅲ型16例）（71.7%,76/106）,混合性尿失禁10例（9.4%,10/106）。结论盆腔脏器脱垂与SUI密切相关。尿动力学检查在女性盆腔脏器脱垂的诊断治疗方面具有重要指导意义。     

Dynamic magnetic resonance imaging defecography: a diagnostic alternative in the assessment of pelvic floor disorders in proctology

PURPOSE: Standard diagnostic proctologic procedures in the assessment of pelvic floor disorders include clinical evaluation and endoscopy. Particular aspects of combined pelvic floor disorders, especially those involving more than one pelvic compartment, may remain undetected without additional technical diagnostic procedures such as videoproctoscopy, cinedefecography, or colpocystodefecography. The aim of the study was to review the potentials of dynamic magnetic resonance imaging defecography to elucidate the underlying anatomic and pathophysiologic background of pelvic floor disorders in proctologic patients. PATIENTS AND METHODS: Dynamic magnetic resonance imaging defecography was performed in 20 Patients (13 females) with main diagnoses such as rectal prolapse or intussusception, rectocele, descending perineum, fecal incontinence, outlet obstruction, and dyskinetic puborectalis muscle after clinical evaluation. The investigation was performed on a 1.5 T-magnetic resonance imaging machine in supine position. The rectum was filled with Gd-DTPA enriched ultrasound gel. First a T1/T2 weighted investigation of the pelvis was performed, followed by defecography with evacuation of the rectum. Images were obtained in a sagittal plane in a frequency of 1 image/second (true FISP) at rest and during straining. The obtained magnetic resonance imaging video tapes were analyzed off-line with cinematographic evaluation of bladder base, uterus, and anal canal position in relation to the pubococcygeal line by a blinded radiologist. Investigation time was 20 minutes. RESULTS: In dynamic magnetic resonance imaging defecography of the pelvic floor, 12 patients with descending perineum, 10 rectoceles (10 females), 6 cystoceles (6 females), 4 enteroceles (4 females), 8 intussusceptions (5 females), and a dyskinetic puborectalis muscle in 3 males were detected. In 11 females and 3 males multifocal disorders were found, involving more than one compartment in females, whereas in males complex defects were restricted to the posterior compartment. Magnetic resonance imaging defecography revealed diagnoses consistent with clinical results in 77.3 percent and defects in addition to clinical diagnoses in combined pelvic floor disorders in 34 percent. CONCLUSIONS: In complex pelvic floor disorders, involving more than a single defect, dynamic magnetic resonance imaging represents a convenient diagnostic procedure in females and to a lesser extent in males, in particular in terms of dynamic imaging of pelvic floor organs during defecation. In addition to the clinical assessment, dynamic magnetic resonance imaging had clinical impact in proctologic and interdisciplinary treatment.Presented in part at the 116th German Congress of Surgery, 1999     

Laparoscopic surgery for rectal prolapse and pelvic floor disorders

Pelvic floor disorders are different dysfunctions of gynaecological, urinary or anorectal organs, which can present as incontinence, outlet-obstruction and organ prolapse or as a combination of these symptoms. Pelvic floor disorders affect a substantial amount of people, predominantly women. Transabdominal procedures play a major role in the treatment of these disorders. With the development of new techniques established open procedures are now increasingly performed laparoscopically. Operation techniques consist of various rectopexies with suture, staples or meshes eventually combined with sigmoid resection. The different approaches need to be measured by their operative and functional outcome and their recurrence rates. Although these operations are performed frequently a comparison and evaluation of the different methods is difficult, as most of the used outcome measures in the available studies have not been standardised and data from randomised studies comparing these outcome measures directly are lacking. Therefore evidence based guidelines do not exist. Currently the laparoscopic approach with ventral mesh rectopexy or resection rectopexy is the two most commonly used techniques. Observational and retrospective studies show good functional results, a low rate of complications and a low recurrence rate. As high quality evidence is missing, an individualized approach is recommend for every patient considering age, individual health status and the underlying morphological and functional disorders.