生物网片材料在女性盆底重建中的应用

背景：与传统的全子宫切除+阴道前后壁修补手术相比,应用网片材料进行盆底重建能更好修补缺陷,实现结构重建和组织替代。 目的：评价生物补片材料在女性盆底器官脱垂手术中的应用情况、临床效果、并发症和不同手术方法对避免术后并发症的作用。 方法：采用电子检索的方式在万方数据库中检索1999/2010有关生物补片用于盆底功能障碍性疾病手术治疗的研究,关键词为“生物补片,盆腔重建”。排除重复研究、普通综述或Meta分析类文章,筛选纳入30篇文献进行评价。 结果与结论：目前用于盆底重建的材料有聚丙烯网片和Prolift专用网片,植入盆底后可显著加强盆底筋膜结构,重建阴道膀胱筋膜、直肠阴道筋膜及悬吊阴道穹窿部,恢复盆底脏器的解剖结构;且手术时间短,可迅速缓解患者症状,围手术期及术后随访无严重并发症,效果良好。用于盆底重建的材料选择很多,植入方法有多种,在实际操作中,应根据患者实际情况采取相应的措施,以达到最满意的效果。     

钛网片在前颅底手术颅底重建中的美容作用

目的 探讨钛网片和带蒂颅骨膜在伴有较大颅底缺损的前颅底手术颅底重建术中的美容作用。方法 将钛网片放在折叠的具有良好血供的带蒂颅骨膜两层之间，对23例具有较大颅底缺损的患者进行颅底重建。结果 23例手术后无感染出现，无脑膜脑膨出，及局部塌陷，颅眶畸形得以矫正，容貌恢复满意，6例术后出现短时间脑脊液鼻漏，经腰穿和静脉预防性应用抗生素痊愈。结论 应用钛网片和血供良好的带蒂颅骨膜重建前颅底有很好的美容作用。     

应用轻型与重型网片开放式修补腹股沟疝的Meta分析

背景：目前对于轻型网片及重型网片修补腹股沟疝谁更具优势存在争议。 目的：采用Meta分析的方法比较重型与轻型补片开放式修补腹股沟疝的疗效。 方法：计算机检索PubMed、Cochrane library、EMBASE、Medline、Ovid、万方、知网、维普、中国生物医学文献数据库、康健等数据库, 并追查已纳入研究的参考文献,检索时间从建库至2013年2月。收集比较重型与轻型补片应用于开放式腹股沟疝修补的前瞻性随机对照试验,按预设标准进行筛选,对纳入研究进行质量评价,提取数据后用RevMan5.1软件进行Meta分析。 结果与结论：纳入18个随机对照试验,共4 450例腹股沟疝。Meta分析结果显示,与重型网片相比,轻型网片修补腹股沟疝后短期内疼痛及异物感较少[OR=0.57,95%可信区间(0.43, 0.74),P < 0.05]、[OR=0.49,95%可信区间(0.35, 0.69),P < 0.05];两组修补手术后复发、血清肿、血肿、切口感染、睾丸萎缩、尿潴留、中长期疼痛方面差异无显著性意义(P > 0.05)。现有证据表明,轻型网片修补腹股沟疝是安全可行的,能达到与重型网片相似的临床疗效,但因纳入文献的质量不高及样本量有限,上述结论需要大样本及高质量的临床随机对照试验来提供更好的循证证据。     

脂肪源干细胞与聚丙烯网片的生物相容性研究

目的观察脂肪源干细胞(ADSCs)与聚丙烯网片的生物相容性。方法制备兔ADSCs悬液。取聚丙烯网片浸提液培养ADSCs。用四甲基偶氮唑盐(MTT)法检测细胞活力,评价支架细胞毒性。ADSCs传代扩增后,接种到聚丙烯网片支架上,体外培养1周。用扫描电子显微镜观察细胞在支架上黏附生长及增殖。结果 ADSCs在聚丙烯网片浸提液中可保持较高的增殖率(RGR)(24、48、72 h实验组细胞RGR分别为97%、96%、101%,平均RGR为103.5%),与对照组比较,差异无统计学意义(χ2=17.45,P0.05),聚丙烯网片浸提液无细胞毒性。脂肪干细胞种植于两种支架材料后生长速度快,扫描电子显微镜观察可见脂肪干细胞呈球型,并伸展形成伪足,贴附于支架材料,细胞间相互连接成团。结论聚丙烯网片支架与ADSCs具有良好的生物相容性,无细胞毒性,可作为脂肪组织工程较理想的生物支架材料。     

巴德（Bard）疝环充填式网塞及网片在腹外疝中的应用

传统的腹外疝修补术是一种有张力修补,且不符合解剖生理,故导致术后５年复发率高达１０－１５％。而巴德公司提供的Ｍａｒｌｅｘ材料是由聚丙烯单丝织成的圆锥形网塞及网片,近年来用于疝修补术,已受到人和临床医师的喜爱和欢迎,因此种修补是一无张力产,其材料不仅有强大的抗感染能力,与组织的相容性强,且承受腹腔内压力,使术后复发率明显下降。我院外科于１９９８年４月以来,先后对２０例腹外疝病人有网这主网片进行修补,     

无张力疝修补术100例临床分析

目的 总结无张力疝修补术在腹股沟应用的经验.方法 对100例腹股沟疝在麻醉下行无张力疝修补术的临床资料进行回顾性分析.结果 100例患者术后均无复发,下床活动早,术后无特殊不适.结论 无张力疝修补术在腹股沟应用方法简单、可靠、经济、安全,术后恢复快、并发症少,值得推广.     

基于新鲜尸体的结构化培训在经阴道植入网片盆底重建手术教学中的应用

目的探讨基于新鲜尸体标本的结构化培训对学员掌握经阴道植入网片盆底重建手术的效果。方法选择北京协和医学院盆底专业博士研究生及专科进修医共9人,依次完成规定自学课程、参观手术演示和尸体解剖教学、尸体标本手术演练过程。根据调查问卷结果比较培训前后自我评价指标。结果学员自我评价培训后的理论水平和操作能力均有明显提高,对手术解剖、手术步骤和并发症处理方面的自信度也显著提高(P0.05)。结论基于新鲜尸体标本的结构化培训在经阴道植入网片盆底重建术的教学中是可行的、有效的。     

应用聚丙烯网片行全盆底重建术

目的探讨应用聚丙烯网片行全盆底重建术的可行性及有效性。方法我院2006年9月～2007年10月对36例盆腔器官脱垂的患者应用聚丙烯网片重建膀胱阴道筋膜、主、骶韧带及阴道直肠筋膜,对合并有压力性尿失禁的患者同时行经闭孔无张力尿道中段悬吊术。结果手术时间为（80&#177;23）min,术中出血量为（100&#177;28）ml,无一例膀胱、尿道、直肠、血管损伤。术后随访3～15个月,患者盆腔器官脱垂全部得以纠正,术前症状消失。术后无复发,均未出现感染、网片侵蚀等并发症,大小便正常。结论应用聚丙烯网片行全盆底重建术是一种微创又经济的手术方式,从近期效果来看,是可行有效的,远期效果有待进一步观察。     

纳米银-猪小肠黏膜下层与聚丙烯网片修复兔腹壁损伤对比

背景：因为自体取材修复腹壁缺损是以伤治伤,而且取材有限,限制了临床应用,因此寻找理想的腹壁替代材料至关重要。 目的：比较复合修复材料纳米银-猪小肠黏膜下层与聚丙烯网片在腹壁缺损中的应用效果。 方法：大耳兔制备兔腹壁损伤实验模型后随机数字表法分为2组,实验组应用复合材料修复腹壁缺损;对照组应用聚丙烯网片修复腹壁缺损。观察修复后动物一般恢复情况,于修复后1,2,4个月进行腹壁抗张强度测定、腹腔内粘连评分以及组织学检测。 结果与结论：相同时间点实验组粘连度显著低于对照组(P < 0.05);各组4个月腹腔粘连度均较1个月增加(P < 0.05)。两组抗拉力强度修复后4个月均高于修复后1个月(P < 0.01);实验组修复后1,2个月抗拉力强度高于对照组(P< 0.05),到第4个月时,修补处强度几乎相等(P > 0.05)。提示两种修复材料均具有良好的修复能力,修复后均能维持足够的腹壁抗张强度。但复合材料在组织相容性、抗腹腔粘连方面优于聚丙烯网片。自制的纳米银-猪小肠黏膜下层补料无细胞毒性,作为组织工程材料修复腹壁损伤具有可行性。     

Y形网片在女性盆底功能疾病中的应用

BACKGROUND: The Y-shaped mesh graft material weaved using lightweight polypropylen has the appropriate porosity, which not only can make the vaginal tissues grow and fuse rapidly on the mesh, but also can maintain good biological strength to ensure the fixed strength for the presacral suspension. OBJECTIVE: To retrospectively analyze the clinical effect of Y-shaped mesh for the biological function reconstruction of the female pelvic floor. METHODS: Ten female cases of pelvic floor dysfunction were enrolled, aged 37-73 years, and all were given the treatment of sacral colposuspension under laparoscopy. Then perioperative complications were recorded; patients were followed up regularly to record the Pelvic Organ Prolapse Quantification (POP-Q) score at different time points; and the subjective satisfaction was investigated using the Pelvic Floor Impact Questionnaire (PFIQ-7). RESULTS AND CONCLUSION: After at least 6-month follow-up, no postoperative pelvic infection, nerve damage and complications appeared, the patients healed well, and no mesh erosion, infection and other adverse reactions occurred. The POP-Q and PFIQ-7 scores at 1, 3 and 6 months after repair were significantly improved than those before repair (P < 0.05). These results suggest that the Y-shaped biological mesh repairing female midpelvic floor dysfunction has good biocompatibility, and can restore the anatomy of the pelvic floor.     

聚丙烯补片在改良盆底重建修复盆腔脏器脱垂中的应用

背景：合成补片是重要的盆底组织替代物,能够替代薄弱受损的盆底筋膜组织,己被广泛应用于盆底薄弱组织的修补重建中。 目的：观察补片在改良盆底重建修复盆腔脏器脱垂的疗效及并发症,探讨其安全性及有效性。 方法：纳入45例女性盆腔脏器脱垂患者,根据患者意愿分两组治疗,试验组25例经阴道植入聚丙烯补片进行改良盆底重建修复,对照组20例采用传统经阴道全子宫切除联合阴道壁修补治疗,记录两组围手术期情况,随访评价两组子宫脱垂分期、并发症、盆底功能及盆底不适情况,以及客观治愈率。 结果与结论：与对照组比较,试验组手术时间短、出血量小、感染轻、恢复快(P均 < 0.05)。随访6个月时,试验组子宫脱垂分期评分高于对照组;随访12个月时,试验组并发症发生率、盆底功能影响评分及盆底不适情况评分均低于对照组(P < 0.05),客观治愈率高于对照组(P < 0.05)。表明采用聚丙烯补片进行盆底重建修复盆腔脏器脱垂具有手术时间短、出血量小、恢复快、裸露率低等特点,同时能显著提高盆底功能,改善盆底不适情况,降低术后并发症的发生,提高客观治愈率,短期随访安全有效。中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程全文链接：     

Gynemesh聚丙烯补片在盆底重建中的应用效果

BACKGROUND: Gynemesh is a polypropylene fabric woven by monofilament polypropylene shaped into a flat form, with a strong tensile strength, small foreign body reaction and good biocompatibility. OBJECTIVE: To investigate the effect of Gynemesh on pelvic floor reconstruction. METHODS: Gynemesh was prepared by the chemical reduction method in the liquid-phase, and observed histologically. Then its thickness, elongation at break, tensile strength, and elasticity modulus were detected. Eight female New Zealand rabbits were used to make pelvic floor dysfunction models by a vaginal balloon, and randomly assigned into experimental group (pelvic floor reconstruction using Gynemesh) or control group (vaginal wall repair and hysterectomy), respectively. Thirty days post surgery, the Pelvic Floor Impact Questionnaire (PFIQ-7) and Pelvic Floor Distress Inventory (PFDI-20) were detected and compared between two groups. RESULTS AND CONCLUSION:The Gynemesh had a thickness of (0.37±0.14) mm, an elongation at break of (25.35±2.68)%, a tensile strength of (7.69±1.17) MPa, and an elastic modulus of (0.007±0.008) GPa. Under the light microscope, a large amount of pink collagen fibers arranged neatly on the Gynemesh, but no blue nuclear material and residual cells existed. Under the scanning electron microscope, the fibers were tightly packed with no residual cells on the Gynemesh. At 30 days after surgery, the Gynemesh was not degraded and no erosion reaction occurred in the experimental group. Moreover, the experimental group had a lower incidence of complications compared with the control group (P < 0.05). These findings indicate that the Gynemesh has good biological performance and it is an ideal material for pelvic floor reconstruction.     

A randomized prospective study comparing new vaginal cone and FES-Biofeedback

Several different methods of enhancing pelvic floor functions have been developed and modified. The aim of this study was to compare the efficacy of a new vaginal cone with conventional FES-Biofeedback therapy for female urinary incontinence, with respect to pelvic floor rehabilitation. One hundred and twenty patients, who required a non-surgical treatment for urinary incontinence, were divided randomly into two groups; (1) the Functional Electrical Stimulation (FES)- Biofeedback group (or BFB group) and (2) the new vaginal cone group (or cone group). For a period of six weeks, two training sessions each week were carried out on the BFB group. The new 150-gram dumbbell-shaped vaginal cone, made of fine ceramic material, was developed domestically. A therapist instructed patients in the cone group upon its use for pelvic floor exercise, and directed the exercise to be repeated at home daily; these patients had follow-up visits every week. Objective improvements were obvious in both groups. 88.3% and 91.6% of the cone and BFB groups showed an improvement after treatment, respectively. There was no significant difference in the improvement or dissatisfaction scores of the two groups. In conclusion, no significant differences in the therapeutic effects were observed between the FES- Biofeedback and the new vaginal cone groups. Considering improvements in the quality of life and objective symptoms, the therapeutic effects of the two techniques showed no significant differences. The new vaginal cone is relatively easy to use at home and aids in pelvic floor muscle exercises. Consequently, the new vaginal cone could be used as an alternative non-surgical treatment modality in female stress urinary incontinence.     

生物源性材料在女性盆底重建中的作用

背景：生物源性材料用于盆底重建手术有望克服合成补片的近期及中远期并发症。异种生物植入材料因其材料来源广泛,已成为女性盆底重建领域材料学的研究热点。 目的：总结近年来生物补片在女性盆底重建领域的基础及临床研究现状,对不同属性的生物植入材料的临床疗效及并发症情况进行综述。 方法：应用计算机检索CNKI和PubMed数据库中2000-01/2010-08关于女性盆底重建中生物源性材料的文章。在标题和摘要中以“xenograft: surgical mesh: biomaterial: prolapse: stress urinary incontinence” 或“生物材料;盆底重建;子宫脱垂;压力性尿失禁” 为检索词进行检索。 结果与结论：初检得到177篇文献,对符合条件的35篇文献进行汇总分析发现,生物补片的组织学反应主要由其化学交联结构和孔隙率决定。因生物补片自身属性、手术方式、入组标准及随访标准差异,临床疗效及并发症研究报道结果均存在显著差异。患者年龄和既往盆底手术史是影响手术重建成功率的主要因素。目前,尚缺乏大样本临床证据支持生物补片在盆底重建中优于合成补片。     

基于盆底超声分析分娩方式对初产妇产后早期盆底结构的影响

目的 探讨应用盆底超声检查分析不同分娩方式对初产妇产后早期盆底结构的影响。方法 回顾性队列研究。选取2020年4—10月安徽理工大学第一附属医院妇产科门诊就诊的初产妇175例,年龄20~35 (26.8±2.8)岁,均为足月、单胎,产后6~8周。根据分娩方式不同分为两组,其中经阴道分娩组102例、剖宫产组73例。采用盆底超声测量所有产妇静息和Valsalva状态下膀胱逼尿肌厚度、膀胱颈与耻骨联合间的距离、膀胱后角、膀胱颈移动度、尿道旋转角、肛直角、肛提肌平均厚度和肛提肌裂孔面积指标。(1)比较两组产妇的年龄、孕期增长体质量、孕周及新生儿体质量的差异;(2)比较两组产妇盆底受损情况;(3)比较静息和Valsalva状态下两组超声测量指标的差异;(4)比较经阴道分娩组不同盆底功能障碍疾病Valsalva状态下的超声测量指标。结果 (1)两组患者的年龄、孕期增长体质量、孕周及新生儿体质量比较,差值均无统计学差异(P值均＞0.05)。(2)盆底受损情况:阴道分娩组与剖宫产组患者产后子宫脱垂分别为34例(33.3%)和9例(12.3%),差异有统计学意义(χ²=10.129, P＜0.05),压力性尿失禁、尿道漏斗形成、膀胱膨出和直肠膨出差异均无统计学意义(P值均＞0.05)。(3)静息状态下,阴道分娩组膀胱后角、肛直角和肛提肌裂孔面积均大于剖宫产组,差异均有统计学意义(t=3.211、2.658、2.835,P值均＜0.05);Valsalva状态下,阴道分娩组膀胱颈与耻骨联合的距离明显小于剖宫产组,分别为(-8.2±7.9)mm和(6.3±7.0)mm,而膀胱颈移动度、膀胱后角、尿道旋转角和肛提肌裂孔面积均大于剖宫产组,差异均有统计学意义(P值均＜0.05)。(4)子宫脱垂患者的肛提肌裂孔面积、膀胱颈移动度和尿道旋转角大于Ⅱ型膀胱膨出和尿道漏斗形成患者,而尿道漏斗形成的患者膀胱后角最大,差异均有统计学意义(P值均＜0.05)。结论 盆底超声清楚地显示产后早期女性盆底结构的变化,阴道分娩者较剖宫产分娩者的盆底损伤严重。     

CNKI数据库中补片在女性盆底重建应用中的文献计量学研究**

背景：补片材料在盆底修复外科的应用早已得到了肯定,并已引起越来越多研究者的关注。 目的：利用CNKI数据库文献检索功能,深度分析补片在女性盆底重建中的应用文献资料趋势,进行多层次探讨分析。 设计：文献计量学分析。 资料提取：以“妇产科(obstetrics and gynecology),盆底(pelvic floor),重建(reconstruction),补片(mesh),聚丙烯(polypropylene)”为关键词,检索CNKI数据库2002-01/2011-12的相关文献,并分析结果,以文字和图表的形式进行统计和计量分析,描述其分布特征。 入选标准：纳入标准：①补片在女性盆底重建中的应用相关的研究论文。②Gynemesh补片在女性盆底重建中的应用相关的研究论文。③Prolift网片在女性盆底重建中的应用相关的研究论文。排除标准：①与文章目的无关的文献。②重复研究的文献。 主要数据判定指标：以出版时间、来源期刊、学科类别、来源数据库、研究机构,以及发表文献的作者分布进行相关分析。 结果：CNKI数据库2002/2011收录的文献中共检索到147篇补片在女性盆底重建中的应用相关文献,在时间分布上文献数量总体呈上升趋势,《中国实用妇科与产科杂志》和《中国妇幼保健》杂志发表文献量较多,6篇,占全部文献的4.08%。 结论：通过文献计量学方法对来源于CNKI数据库关于补片在女性盆底重建中的应用文献进行分析,为了解该领域的概貌、现状和研究者进一步确定热点难点提供了有价值的参考。关键词：补片;Gynemesh聚丙烯补片;妇产科;盆底;重建;Prolift网片;文献计量分析 doi:10.3969/j.issn.1673-8225.2012.16.032     

Single-blind, randomized, controlled trial of pelvic floor muscle training, electrical stimulation, vaginal cones, and no active treatment in the management of stress urinary incontinence

PURPOSE: To compare the effectiveness of pelvic floor exercises, electrical stimulation, vaginal cones, and no active treatment in women with urodynamic stress urinary incontinence. PATIENTS AND METHODS: One hundred eighteen subjects were randomly selected to receive pelvic floor exercises (n=31), ES (n=30), vaginal cones (n=27), or no treatment (untreated control) (n=30). Women were evaluated before and after completion of six months of treatment by the pad test, quality of life questionnaire (I-QOL), urodynamic test, voiding diary, and subjective response. RESULTS: In the objective evaluation, we observed a statistically significant reduction in the pad test (p=0.003), in the number of stress urinary episodes (p<0.001), and a significant improvement in the quality of life (p<0.001) in subjects who used pelvic floor exercises, electrical stimulation, and vaginal cones compared to the control group. No significant difference was found between groups in the urodynamic parameters. In the subjective evaluation, 58%, 55%, and 54% of women who had used pelvic floor exercises, electrical stimulation, and vaginal cones, respectively, reported being satisfied after treatment. In the control group, only 21% patients were satisfied with the treatment. CONCLUSION: Based on this study, pelvic floor exercises, electrical stimulation, and vaginal cones are equally effective treatments and are far superior to no treatment in women with urodynamic stress urinary incontinence.     

Vaginal cone use in passive and active phases in patients with stress urinary incontinence

OBJECTIVE:

To evaluate vaginal cone therapy in two phases, passive and active, in women with stress urinary incontinence.

METHODS:

A prospective study was conducted at the Department of Obstetrics and Gynecology, São Paulo University, Brazil. Twenty-four women with a clinical and urodynamic diagnosis of stress urinary incontinence were treated with vaginal cones in a passive phase (without voluntary contractions of the pelvic floor) and an active phase (with voluntary contractions), each of which lasted three months. Clinical complaints, a functional evaluation of the pelvic floor, a pad test, and bladder neck mobility were analyzed before and after each phase.

RESULTS:

Twenty-one patients completed the treatment. The reduction in absolute risk with the pad test was 0.38 (p<0.034) at the end of the passive phase and 0.67 (p<0.0001) at the end of the active phase. The reduction in absolute risk with the pelvic floor evaluation was 0.62 (p<0.0001) at the end of the passive phase and 0.77 (p<0.0001) at the end of the active phase. The reduction in absolute risk of bladder neck mobility was 0.38 (p<0.0089) at the end of the passive phase and 0.52 (p<0.0005) at the end of the active phase. Complete reversal of symptomatology was observed in 12 (57.1%) patients, and satisfaction was expressed by 19 (90.4%).

CONCLUSION:

Using vaginal cones in the passive phase, as other researchers did, was effective. Inclusion of the active phase led to additional improvement in all of the study parameters evaluated in women with stress urinary incontinence. Randomized studies are needed, however, to confirm these results.