使用Mersilene带的新式子宫阴道耻骨梳悬吊术在盆腔器官脱垂治疗中的应用

目的:探索使用Mersilene带的新式子宫阴道耻骨梳悬吊(UPCS)手术在盆腔器官脱垂(POP)治疗中的经济适用性与安全性。方法:回顾性分析2021年1月1日至2023年2月28日因POP就诊且需行UPCS手术患者的临床资料，分为Mersilene带子宫阴道悬吊手术组(A组)和Y型网片子宫阴道悬吊手术组(B组)。记录两组患者术前及术后的POP-Q指示点位置、悬吊术式时长、术中出血量、术后尿管留置时间、术后肛门排气时间、住院费用和住院时间。以盆底功能障碍问卷(PFDI-20)和盆腔器官脱垂尿失禁性功能问卷(PISQ-12)评估术前和术后患者POP相关症状严重程度，对患者进行随访观察并统计并发症情况。结果:共纳入17例POP患者，其中A组12例，B组5例。A组术式住院费用远低于B组(P<0.05),两组患者在术前PFDI-20评分、术前PISQ-12评分、悬吊手术时长、术中出血量、术后尿管留置时间、术后肛门排气时间及住院时间差异无统计学意义(P>0.05)。术中所有患者的生命体征平稳，无严重近期术后并发症发生。术后末次随访与术前的POP-Q指示点对比，A组及B组的Aa点、Ba点、C点在术后均显著上升(P<0.05)。两组患者术后末次随访的PFDI-20评分和PISQ-12评分均较术前有显著改善(P<0.05),术后两组PFDI-20评分和PISQ-12评分差异无统计学意义(P>0.05),术后两组随访远期并发症发生率差异无统计学意义(P>0.05)。结论:与Y型网片子宫阴道悬吊手术相比，使用Mersilene带的UPCS手术在POP治疗中安全有效，其在POP的治疗中具有更好的成本经济效应，且手术步骤相对简单，具有一定的可推广性。     

腹腔镜下全子宫切除联合高位宫骶韧带悬吊术治疗子宫脱垂的疗效分析

目的 探讨腹腔镜下全子宫切除联合高位宫骶韧带悬吊术治疗子宫脱垂的临床疗效及其对性生活的影响。方法 选取72例接受手术治疗的盆腔器官脱垂定量（POP-Q）分度Ⅱ～Ⅲ度子宫脱垂伴（不伴）阴道前后壁膨出患者,采用随机数字表法分为研究组与对照组,每组36例。研究组患者接受腹腔镜下全子宫切除联合高位宫骶韧带悬吊术,对照组患者接受经阴道全子宫切除术。比较两组临床疗效。结果 研究组总有效率为91.67%,显著高于对照组的72.22%,差异有统计学意义（P<0.05）。治疗前,两组盆底不适调查简表-20(PFDI-20)问卷中盆腔器官脱垂影响量表（POPDI-6）、肠道脱垂影响量表（CARDI-8）、排尿相关症状影响量表（UDI-6）评分及总分比较,差异无统计学意义（P>0.05）;治疗后,两组PFDI-20问卷中3个分量表评分及总分明显低于治疗前,且研究组明显低于对照组,差异有统计学意义（P<0.05）。研究组中有5例患者、对照组中有3例患者因惧怕术后复发等心理因素未有性生活。治疗前,两组盆腔器官脱垂/尿失禁性生活质量问卷-31(PISQ-31)中情感、生理、性伴侣因素评分及总分比...     

腹腔镜子宫悬吊术与传统阴式子宫切除术均联合阴道前后壁修补治疗盆腔器官脱垂的疗效比较

目的:比较腹腔镜子宫悬吊术与传统阴式子宫切除术均联合阴道前后壁修补治疗盆腔器官脱垂(POP)的疗效。方法:选择2017年1月至2019年9月本院收治的POP患者96例为研究对象,国际尿控协会POP量化分期(POP-Q)为Ⅱ～Ⅳ期,采用随机数字表法将其分为观察组(49例)采用腹腔镜子宫悬吊术联合阴道前后壁修补术,对照组(47例)采用传统阴式子宫切除联合阴道前后壁修补术,对比两组手术相关指标及手术前后盆底不适调查表短表20评分(PFDI-20),及其分量表(POPDI-6)、肠道脱垂分量表(CARDI-8)、排尿有关症状分量表(UDI-6)和盆底功能解剖学参数Aa、Ba、C、Ap、Bp、TVL变化,以女性性功能评分量表(FSFI)、性生活质量问卷(PISQ)评估其性生活质量,记录两组并发症及随访1年治愈率、复发率。结果:观察组手术时间、住院时间少于对照组,而术中出血量低于对照组,观察组术后阴道长度较对照组长,差异有统计学意义(P0.05),两组导尿时间比较差异无统计学意义(P0.05);观察组术后6个月PFDI-20总评分及POPDI-6、CARDI-8、UDI-6评分均低于对照组,差异有统计学意义(P0.05);术后6个月两组盆底功能解剖学参数均明显改善,且观察组术后Aa、Ba、C、Ap、Bp、TVL均小于对照组,差异有统计学意义(P0.05);观察组术后6个月FSFI、PISQ评分高于对照组,差异有统计学意义(P0.05);观察组并发症发生率(4.08%)低于对照组(17.02%),差异有统计学意义(P0.05);观察组1年治愈率高于对照组(95.92%vs 82.98%),而复发率低于对照组(2.13%vs 20.51%),差异有统计学意义(P0.05)。结论:与传统阴式子宫切除联合阴道前后壁修补术相比,腹腔镜子宫悬吊术联合阴道前后壁修补术治疗POP有更好的效果,不仅改善手术时间、住院时间、术中出血量,促进术后恢复,增加阴道长度,也可明显改善盆底功能及解剖学参数,提高性生活质量,且并发症发生率低,远期效果好,值得在临床推广实践。     

机器人骶骨阴道固定术与髂耻韧带悬吊术的短期疗效比较

目的:探讨机器人骶骨阴道固定术与髂耻韧带悬吊术对盆腔器官脱垂(POP)患者短期疗效的差异。方法:回顾性分析郑州大学第一附属医院2016年7月至2019年7月收治的62例POP-Q评分Ⅱ度及以上患者的临床资料,其中38例行机器人骶骨阴道固定术,24例行机器人髂耻韧带悬吊术,比较两种术式的手术相关指标、围术期并发症的差异,对近期疗效的比较采用盆底功能障碍问卷(PFDI-20)表和盆底障碍影响问卷简表(PFIQ-7)。结果:(1)机器人骶骨阴道固定术组的手术时间明显长于髂耻韧带悬吊术组(150.75±43.99分钟vs 109.83±18.19分钟,P0.001)。两组术中出血量、留置尿管的天数及残余尿量差异无统计学意义(P0.05),两组术后并发症发生率(下肢静脉血栓、肠梗阻/胃肠胀气、骶骨/耻骨骨髓炎)差异无统计学意义(P0.05)。(2)两组术后3月的POP-Q指示点(Aa、Ba、C、Ap、Bp)均分别优于术前(P0.05),恢复正常范围,获得满意的解剖复位。(3)两组术后3月的PFDI-20、PFIQ-7评分组间比较,差异均无统计学意义(P0.05);而两组组内比较,术后3月的PFDI-20、PFIQ-7评分均分别低于术前,差异有统计学意义(P0.05)。(4)两组在随访期间的新发压力性尿失禁、顶端脱垂、网片暴露的发生率差异无统计学意义(P0.05),但骶骨阴道固定组的排便障碍发生率显著高于髂耻韧带悬吊组(18.4%vs 0,P0.05)。结论:两种机器人手术均获得满意的解剖复位,与机器人骶骨阴道固定术相比,机器人髂耻韧带悬吊术手术时间明显缩短,排便障碍发生率显著降低,可成为治疗POP的术式新选择。     

腹腔镜下高位骶韧带悬吊术治疗子宫脱垂的疗效探讨

目的评价腹腔镜下高位骶韧带悬吊术治疗子宫脱垂患者的疗效。方法2008年5月至2012年7月在北京大学第三医院因POP—Q分期Ⅱ～Ⅲ期子宫脱垂行腹腔镜下高位骶韧带悬吊术治疗的患者共lO例,以主观症状和POP—Q测量评价患者的主观、客观治愈率、复发率;并以盆底不适调查表短表20（PFDI-20）评价手术前后患者的生活质量;以盆腔器官脱垂一尿失禁性生活问卷31（PISQ-31）评价手术前后患者的性生活质量。结果患者平均年龄51．32岁（47～62岁）,术后随访率为100％,平均随访时间为14．91个月（2～51个月）。术后主观、客观治愈率均为100％,无并发症发生。术前、术后6个月生活质量评价PFD卜20评分分别为（51．25±3．22）分和（O．22±0．15）分,术前、术后6个月性生活质量评价PISQ-31评分分别为（64．25±8．34）分和（96．44±8．12）分,两者术前、术后比较,差异均有统计学意义（P〈0．05）。结论腹腔镜下高位骶韧带悬吊术治疗子宫脱垂患者的疗效确切,可明显改善患者的生活质量及性生活质量。     

盆底重建联合全子宫切除术治疗重度子宫脱垂的手术护理配合效果研究

目的 探讨重度子宫脱垂患者在接受盆底重建联合全子宫切除术治疗期间给予手术护理配合后的临床效果。方法 选取70例重度子宫脱垂患者,根据数字奇偶法分为围手术期护理组与常规护理组,每组35例。围手术期护理组采用常规护理+围手术期护理方式配合完成盆底重建+全子宫切除术治疗,常规护理组采用常规护理方式配合完成盆底重建+全子宫切除术治疗。比较两组并发症（压力性尿失禁、膀胱过度活动症、性交困难及性交痛）发生率、盆底功能障碍问卷简短版-20(PFDI-20)评分、盆底功能影响问卷简短版-7(PFIQ-7)评分及匹兹堡睡眠质量指数量表（PSIQ）。结果 围手术期护理组患者并发症发生率（5.71%）低于常规护理组（37.14%）,差异有统计学意义（P<0.05）;护理前,围手术期护理组PFDI-20评分（69.86±15.72）分、PFIQ-7评分（59.33±12.22）分及PSIQ评分（15.47±1.47）分与常规护理组PFDI-20评分（69.99±15.75）分、PFIQ-7评分（59.35±12.24）分及PSIQ评分（15.49±1.49）分比较,差异无统计学意义（P>0.05）...     

腹腔镜下脱垂子宫腹壁线型悬吊固定术的临床研究

目的 研究腹腔镜下脱垂子宫腹壁线型悬吊固定术的临床效果。方法 选取8例子宫脱垂患者,根据随机数字表法分为对照组与研究组,每组4例。对照组采用传统阴式子宫切除术治疗,研究组采用腹腔镜下脱垂子宫腹壁线型悬吊固定术治疗。比较两组患者围手术期情况、临床出血指标、疼痛程度、生活质量评分、凝血功能及负面情绪。结果 两组患者自主排尿时间、排便时间比较,差异无统计学意义（P>0.05）,研究组患者手术时间、下床活动时间均明显短于对照组,差异有统计学意义（P<0.05）。研究组术中出血量、术后3、12 h出血量均少于对照组,差异有统计学意义（P<0.05）。手术前,两组疼痛评分比较,差异无统计学意义（P>0.05）;手术后1、6、12个月,研究组疼痛评分低于手术前及对照组,差异具有统计学意义（P<0.05）。手术前,两组生活质量评分比较,差异无统计学意义（P>0.05）;手术后,两组生活质量评分高于手术前,且研究组明显高于对照组,差异具有统计学意义（P<0.05）。研究组患者D-二聚体、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）指标均低于对照组,肌钙...     

两种保留子宫治疗子宫脱垂的手术方式的疗效分析

目的:探讨腹腔镜下子宫腹壁悬吊术及子宫骶骨岬悬吊术治疗要求保留子宫的女性盆腔脏器脱垂患者的可行性及临床疗效。方法:回顾分析2012年6月1日至2013年6月1日郑州大学第一附属医院收治的64例要求保留子宫的子宫脱垂患者的临床资料,其中34例行腹腔镜下子宫腹壁悬吊术(研究组),30例行子宫骶骨岬悬吊术(对照组)。比较两组患者的手术时间、术中出血量、住院天数及术后并发症,术后12个月测量患者POP-Q各点值评价术前术后盆底功能改善状况,以盆底不适调查表短表20(PFDI-20)评价手术前后患者的生活质量。结果:64例患者均经腹腔镜成功完成手术,术中无膀胱、输尿管、直肠损伤。研究组的手术时间、术中出血量、住院天数均少于对照组,差异均有统计学意义(P0.05)。术后随访12个月,两组患者均无子宫脱垂复发,POP-Q各点测量值差异无统计学意义(P0.05);两组的术前与术后生活质量调查表问卷得分比较,差异有统计学意义(P0.05)。研究组和对照组分别有3例(8.8%)和2例(6.7%)发生术后并发症。结论:腹腔镜下腹壁子宫悬吊术及子宫骶骨岬悬吊术治疗子宫脱垂安全有效;腹腔镜下腹壁子宫悬吊术具有手术时间短、术中出血量少、经济安全、术后并发症少等优点,有望临床推广。     

腹腔镜下子宫腹壁悬吊联合阴道前壁修补治疗子宫脱垂84例病例分析

目的:分析腹腔镜下子宫腹壁悬吊联合阴道前壁修补术治疗子宫脱垂的有效性及安全性。方法:选择2014年1月至2018年12月因Ⅲ~Ⅳ度子宫脱垂且合并阴道前壁膨出于溧阳市人民医院就诊的患者共84例,采用腹腔镜下简易子宫腹壁悬吊+阴道前壁修补进行治疗,伴有阴道后壁膨出的患者术中同时行阴道后壁桥式修补。术后随访12~72月(平均36.8月),记录患者术中情况、手术并发症及手术前后盆腔器官脱垂定量分度(POP-Q)及盆底功能影响问卷简表(PFIQ-7)评分。结果:腹腔镜下子宫腹壁悬吊+阴道前壁修补术的手术时间为(47.75±6.73)min,术中出血量(49.41±14.44)ml,无术中脏器损伤。术后1年随访客观治愈率97.6%(82/84),手术并发症发生率7.14%(6/84)。术后1年POP-Q评分中Aa、Ba、C、Ap、Bp各点的值均较术前有明显改善。患者术前PFIQ-7评分(116.29±17.97)分,术后6月评分(25.31±10.15)分,术后1年评分(26.32±7.85)分,差异有统计学意义(P<0.01)。结论:腹腔镜下简易子宫腹壁悬吊联合阴道前壁修补术治疗子宫脱垂操作简单,容易掌握,近期有效率高。     

盆底悬吊术与传统经阴道子宫切除术用于治疗盆底功能障碍性疾病的临床疗效比较

目的:比较盆底悬吊术与传统的经阴道子宫切除术在治疗盆底障碍性疾病中的临床疗效。方法:将2007年1月至2008年10月我院收治的100例盆底功能障碍性疾病患者随机分成两组。重建组:开展盆底悬吊术,合并压力性尿失禁者同时实施改良的经闭孔无张力尿道中段悬吊术(TVT-O)。传统组:经阴道切除子宫加阴道前后壁修补术。比较两组术中情况及术后疗效。结果:重建组与传统组比较,手术时间短,术中出血少,排气时间短,保留导尿管时间短,住院时间短,差异均有统计学意义(P<0.05)。术后2个月及术后6个月两组盆腔脏器脱垂复发率无明显差异(P>0.05),但术后1年重建组复发率低于传统组(P<0.05)。术后2个月、6个月及1年,重建组压力性尿失禁复发率及PFDI评分与传统组比较,差异有统计学意义(P<0.05)。两组术前PFDI评分较术后2个月、6个月、1年的差异均有统计学意义(P<0.05)。结论:两组患者生活质量均有明显改善,重建组较传统组疗效更明显。     

深钩引导前盆底重建术与经典术式治疗前盆腔缺陷的疗效及安全性分析#br#

Objective?To compare the efficacy and safety of deep hook guided anterior pelvic floor reconstruction and classic operation in the treatment of pelvic organ prolapse caused by anterior pelvic defects. Methods?The clinical data of 47 patients with deep hook guided anterior pelvic floor reconstruction (observation group) and 63 patients with classic anterior pelvic floor reconstruction (control group) in our department from January 2016 to December 2017 were analyzed retrospectively. The operation time and bleeding volume were compared between the two groups. The complications, prolapse recurrence, subjective and objective satisfaction were compared between the two groups. The postoperative quality of life scores of the two groups were compared (PFDI-20, PFIQ-7, PISQ-12). Results?There were significant differences between scores before and after the operation, in objective satisfaction (POP-Q score), PFDI-20, PFIQ-7, PISQ-12 scores in both two groups (P<0.05). There was no significant difference in objective satisfaction at 1 and 3 months after operation. The objective satisfaction of the observation group was significantly better than that of the control group at 6 months after operation (P<0.05). The PGI-I score showed that the score of the observation group was significantly lower than that of the control group (P<0.05), and there was no significant difference in other parameters. Conclusions?Deep hook guided anterior pelvic floor reconstruction has the obvious advantages of high objective satisfaction and excellent postoperative quality of life. It is a new operation worthy of popularization.     

硅胶子宫托用于女性盆腔器官脱垂的疗效分析

目的探讨硅胶子宫托治疗女性盆腔器官脱垂的临床效果及生活质量改善情况。方法对2009年9月至2012年5月硅胶子宫托保守治疗POP-QⅢ~Ⅳ期盆腔器官脱垂72例患者进行随访,填写盆底功能障碍问卷简表（PFDI-20）和盆底功能影响问卷简表（PFIQ-7）,评价子宫托治疗的疗效。结果 72例盆腔器官脱垂患者中,1例为全盆腔重建术后复发。随访时间24~50个月,平均随访时间（30.71±5.49）个月。13例失访,59例完成随访,随访率为81.94%。59例患者中,35例（59.32%）效果显著,持续佩戴,取放间隔时间为1~4周;24例（40.68%）在3个月内放弃使用子宫托,其中取放困难11例（45.83%）,长期佩戴有不适感8例（33.33%）,易脱落4例（16.67%）,1例83岁患者因偏瘫长期卧床放弃使用。35例患者治疗前PFDI-20和PFIQ-7评分分别为（46.94±36.10）分和（98.23±48.01）分,治疗后6个月分别下降至（6.07±15.63）分和（14.56±11.14）分,治疗后2年分别下降为（3.72±12.76）分和（5.3±4.87）分,与治疗前比较,差异均有统计学意义（P均〈0.05）。结论子宫托可以有效改善盆腔器官脱垂患者的症状,提高生活质量,适合门诊广泛开展应用。     

"协和"全盆底重建术治疗重度盆腔器官脱垂的多中心前瞻性研究

目的 探讨"协和"全盆底重建术治疗重度盆腔器官脱垂(POP)的疗效及对患者生命质量和性生活质量的影响.方法 自2006年6月至2008年12月,在全国8家医疗单位开展多中心前瞻性研究,包括北京协和医院、复旦大学附属妇产科医院、北京大学第一医院、北京大学第三医院、第三军医大学西南医院、四川大学华西第二医院、北京大学人民医院、北京妇产医院,共277例POP患者参加本研究,所有患者术前均为Ⅲ度或Ⅳ度.总结研究的中期结果,通过术后随访患者的POP分度情况了解POP的解剖学改善情况.通过比较患者术前、术后盆底功能影响问卷简表(PFIQ-7)和盆底不适调查表简表(PFDI-20)评分,评估手术对患者生命质量的影响;通过比较术前、术后POP-尿失禁性生活问卷(PISQ)评分,评价手术对患者性生活质量的影响.结果 中位随访时间14个月(6～28个月),23例患者术后复发,复发率为8.3%(23/277).19例(6.9%,19/277)患者在随访中发现网片暴露或侵蚀.术后新发的尿失禁为18例(6.5%,18/277).277例患者术前、术后6个月、术后1年的PFIQ-7评分分别为(66.9±65.1)、(7.2±26.7)、(7.6±31.6)分,PFDI-20评分分别为(75.8±49.0)、(17.4±25.2)、(15.0±22.6)分,术后较术前生命质量评分显著降低,差异均有统计学意义(P＜0.01).术前、术后6个月、术后1年的PSIQ评分分别为(76.6±15.4)、(75.5±14.5)、(73.6±12.6)分,术前与术后比较,差异无统计学意义(P＞0.05),手术对性生活质量无明显影响;但术后9例(11%,9/80)患者新发性交痛.结论 "协和"全盆底重建术是治疗重度POP一种有效、安全的手术,可以明显改善患者的生命质量,与传统的全盆底重建术疗效相当.

Abstract：

Objective To evaluate clinical efficiency and quality-of-life outcomes in treatment of severe pelvic organ prolapse by the "Xiehe" pelvic floor reconstruction surgery. Methods From Jun. 2006 to Dec. 2008, 277 severe pelvic organ prolapse patients with stage Ⅲ to Ⅳ from 8 hospitals in China were enrolled in this prospective study. Pelvic organ prolapse quantitative examination (POP-Q) and anatomic improvement in these patients after surgery were analyzed in this interim study. Comparisons of pelvic floor impact questionnaire-short form 7 (PFIQ-7) and pelvic floor distress inventory-short form 20 (PFDI-20) in these patients before and after surgery was used to evaluate quality of life. Comparison of pelvic organ prolapse-urinary incontinence sexual questionnaire (PISQ) in these patients before and after surgery was used to evaluate quality of sexual life. Results With a median follow-up of 14. 0 months (6 -28 months),twenty-three patients showed recurrent prolapse (8. 3%, 23/277), and anatomical success ( ＜ stage 2 in the treated compartment) was 91.7% (254/277). In this series, mesh exposure or erosion rate was 6. 9% (19/277). The postoperative de novo stress incontinence rate was 6. 5% (18/277). The scores for PFIQ-7 and PFDI-20, and its subscales were significantly improved, the scores of before treatment were lower than those after treatment (P ＜0. 01 ). And there was no significant difference in the average score of PISQ before and after the surgery (76. 6 ± 15.4 versus 75.5 ± 14. 5 versus 73.6 ± 12. 6, P ＞0. 05 ), but the rate of de novo dyspareunia was 11% (9/80). Conclusions "Xiehe" pelvic floor reconstruction surgery was safe and efficacy in treatment of pelvic organ prolapse. It could improve quality of life remarkably with less cost when compared with the traditional total pelvic floor reconstruction surgery.     

Laparoscopic Extraperitoneal Uterine Suspension to Anterior Abdominal Wall Bilaterally Using Synthetic Mesh to Treat Uterovaginal Prolapse

Between August 2007 and May 2009, 28 patients with uterovaginal prolapse, stage 2 or greater, and who desired uterine preservation, underwent laparoscopic extraperitoneal uterine suspension to the anterior abdominal wall bilaterally using mesh. The primary outcome was recurrence, which was evaluated using point C. Secondary outcomes were effects on quality of life (Pelvic Floor Distress Inventory [PFDI-20] and Pelvic Floor Impact Questionnaire [PFIQ-7]) and sexual symptom (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire [PISQ-12]) scores, operative time, blood loss, duration of hospitalization, and adverse events. After surgery, there was significant improvement in all pelvic organ prolapse quantification (POP-Q) measurements. The POP-Q score for point C was significantly farther from the hymen at 6-months and 1-year follow-up compared with the preoperative value (?7.8 and ?8.0 vs 2.6, respectively; p < .001). The objective cure rates at 6 months and 1 year were 96.4% and 94.1%, respectively. There were no major intraoperative or postoperative complications. However, all patients reported postoperative dragging pain at the points of puncture ports where the mesh was fixed to the abdominal wall. The mean visual analog scale decreased from a mean (SD) 3-day score of 2.61 (1.26) to 0 at 1 month follow-up. Baseline PISQ-12 score changed significantly compared with the value at 6 months after operation (28.4 [2.7] vs 29.3 [2.9]; p < .001). The PFDI-20 and PFIQ-7 scores at 6 and 12 months after surgery improved significantly compared with the baseline scores (p < .001). The subjective success rates at 6 months and 1 year were 96.4% and 94.1%. respectively. Laparoscopic extraperitoneal uterine suspension to the anterior abdominal wall using mesh is a simple, safe, and effective procedure for treating uterovaginal prolapse. However, further studies of the long-term efficiency and reliability of this technique are needed to evaluate its value.     

保留子宫Prolift全盆底重建术与传统手术治疗重度盆腔器官脱垂疗效比较

目的比较保留子宫的Prolift全盆底重建术与传统手术(阴式子宫切除+阴道前后壁修补)在治疗女性重度盆腔器官脱垂中的临床疗效。方法对2008年7月至2011年9月中山大学附属第一医院31例盆腔器官脱垂定量分度法(POP-Q)Ⅲ度和Ⅳ度的盆腔器官脱垂患者施行保留子宫的Prolift全盆底重建术(重建组),与同期43例施行传统手术治疗(阴式子宫切除+阴道前后壁修补)(传统组)的病例进行比较。通过POP-Q评价解剖恢复疗效,盆底功能障碍影响简易问卷(PFIQ-7)评价功能恢复疗效,同时分析性生活及术中术后并发症等情况。结果两组平均手术时间、术中出血、术后住院天数比较差异均无统计学意义(P>0.05);重建组尿管留置时间短于传统组(P<0.05)。两组术后POP-Q分度各指示点、PFIQ-7评分均较术前改善(P<0.05),术后总阴道长度(TVL)重建组大于传统组(P<0.05),其他指标两组间比较差异无统计学意义(P>0.05)。解剖治愈率重建组96.77%(30/31)高于传统组79.07%(34/43)(P<0.05)。重建组患者主观满意度95.74%,传统组95.37%,差异无统计学意义(P>0.05)。两组术中均未出现严重并发症,但重建组7例,传统组6例,术后发生压力性尿失禁。重建组术后出现性交痛例数比(2/3)大于传统组(1/6)。结论保留子宫的Prolift全盆底重建术有更好的解剖恢复疗效,但盆底功能恢复和患者主观满意度方面与传统手术治疗比较差异无统计学意义。盆底修复手术术前应仔细评估尿控情况,防止术后出现排尿异常。对性生活较活跃患者,采用Prolift全盆底重建术时应慎重。     

内分泌治疗对乳腺癌术后子宫内膜病变患者生活质量的临床观察#br#

Objective?To investigate the effect of endocrine therapy on the life quality of patients with endometrial lesions after breast cancer surgery. Methods?A total of 69 cases of breast cancer patients with uterine endometrial lesions after endocrine therapy were selected and divided into two groups randomly: ovarian function suppression (OFS) combined with aromatase inhibitor (AI) group (group A, n=34), OFS combined with Moxifen (TAM) group (group T, n=35). The life quality scores, endometrial changes and adverse reactions were compared between the two groups of patients at different periods. Results?The scores of four dimensions of life quality in group A at 6th and 12th months after treatment were higher than those in group T (P<0.05). The 12-month endocrine symptom scores in group A were higher than those in the group T (P<0.05). The incidence rates of endometrial hyperplasia, endometrial atrophy and endometrial polyps in group A were 41.18%, 20.59%, and 17.65%, respectively, which were lower than those in group T (60.00%, 34.29%, 34.29%) (P<0.05). At the 12th month, the endometrial thickness of patients in group A [(7.87±2.54) mm] was higher than that in group T [(6.23±1.18) mm] (P<0.05). Conclusions?Different endocrine drugs have different effects on the life quality and endometrium of patients. In this study, OFS combined with aromatase inhibitor therapy improved the life quality better than OFS combined with tamoxifen.     

Cultural adaptation and validation of the Pelvic Floor Distress Inventory Short Form (PFDI-20) and Pelvic Floor Impact Questionnaire Short Form (PFIQ-7) Spanish versions

Objective

To develop a linguistically adapted and psychometrically validated Spanish version of the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire Short Forms (PFDI-20 and PFIQ-7) to assess symptoms and quality of life in Spanish women with pelvic floor disorders.

Study design

Cross-cultural linguistic adaptation was performed following the translation–backtranslation method in 30 native Spanish-speaking women with pelvic floor disorders to obtain PFDI-20 and PFIQ-7 Spanish versions. The psychometric properties were evaluated in 114 women with pelvic floor disorders. We calculated the reliability with the intraclass correlation coefficient and Cronbach's alpha coefficient, the validity with Spearman coefficient, the feasibility with the response rate and the filling time, and the ceiling and floor effects.

Results

Spanish versions of the PFDI-20 and PFIQ-7 achieved good semantic, conceptual, idiomatic and content equivalence. Concerning the psychometric validation, internal consistency was high with Cronbach's alpha coefficient of 0.837 (p < 0.001) for PFDI-20 and 0.967 (p < 0.001) for PFIQ-7. The test–retest reliability was 0.644 (p < 0.001) for the PFDI-20 and 0.786 (p < 0.001) for the PFIQ-7. Good construct validity was found with questionnaires: SF-12, EPIQ and ICIQ-SF. The average administration time was 10.1 (5.8) min for the PFDI-20, and 7.5 (4.7) min for the PFIQ-7. A ceiling effect was detected in the PFIQ-7 (25.4%).

Conclusions

The PFDI-20 and PFIQ-7 Spanish versions showed semantic, conceptual, idiomatic and content equivalence with the original versions. Both instruments are reliable, valid and feasible to evaluate symptoms and quality of life in Spanish women with pelvic floor disorders.     

Prolift系统盆底重建术的临床疗效及对患者生活质量的影响

目的研究女性Prolift系统盆底重建术的临床疗效及对患者生活质量的影响。方法回顾性分析2007年1月至2010年6月因重度盆腔器官脱垂（POP）在北京大学人民医院妇科接受Prolift系统进行盆底重建手术治疗的98例患者的资料,通过比较患者术前、术后POP-Q分期、盆底功能影响问卷-简表7（PFIQ-7）、盆底功能障碍问卷-20（PFDI-20）及性生活质量问卷-31评分情况,评价Prolift盆底重建系统在妇科的应用价值。结果 98例患者中83例患者按时随访并回收问卷,平均随访时间（34.07±23.43）个月。患者平均手术时间（82.34±26.78）min;平均术中出血量（109.06±70.45）ml。无术中严重并发症。解剖治愈率87.95%（73/83）。脱垂复发10例（12.05%）,补片侵蚀7例（8.43%）,盆腔血肿4例（4.82%）。术前合并压力性尿失禁（SUI）37例患者同时行抗尿失禁手术,术后SUI症状消失33例（89.19%）,而术前无SUI的患者中术后有14.29%出现了SUI。调查问卷显示,患者术后生活质量有明显改善,但术前、术后性生活质量比较,差异无统计学意义（P〉0.05）。结论应用Prolift行盆底重建术可明显提高患者的生活质量,复发率较传统手术低。术后新发SUI应引起重视。远期效果还需长期随访。     

Comparative mid-term anatomical and functional outcomes following laparoscopic sacrocolpopexy in women under and over 65: results from a prospective study

Purpose

To compare mid-term anatomical and functional outcomes following laparoscopic sacrocolpopexy (LS) between women under and over 65.

Methods

Prospective and observational study involving patients with symptomatic pelvic organ prolapse (POP) undergoing LS. Study population was stratified according to patients’ age at the time of surgery. POP symptoms and impact on quality of life were assessed by PFIQ-7 and PFDI-20 questionnaires at baseline and during follow-up.

Results

Among our study population (n?=?72), 26 women were over 65 and 46 under 65. Mean follow-up duration was 17.6 months, and complete follow-up was available in 90% of patients. No differences between study groups were observed regarding surgery duration, length of stay, and peri-operative complications. Recurrence rate was 1.4% at 18 months of follow-up. Questionnaires analysis revealed a significant improvement in PFIQ-7 and PFDI-20 scores. We found no differences in post-operative scores between control and elderly groups. Sixteen patients experienced de novo stress urinary incontinence (22.2%), with no difference between groups (p?=?0.7). Among them, seven required surgical management.

Conclusions

LS was associated with high anatomical success rate and good functional outcomes, regardless of age at the time of surgery. LS should thus be considered in women over 65. Beyond age, the route of surgery should be driven by patient’s choice and medical condition.