大气颗粒物暴露对小鼠妊娠和胚胎发育的影响

目的 探讨大气颗粒物(PM)亚急性暴露对小鼠妊娠和胚胎发育的影响.方法选择雌、雄小鼠各40只按1∶1合笼,将妊娠的雌鼠随机分为对照(A组)、小剂量PM暴露(B组)、中剂量PM暴露(C组)、大剂量PM暴露(D组)、超大剂量PM暴露(E组),每组8～11只.从妊娠0～19 d分别向A组小鼠咽后壁接种磷酸盐缓冲液,向B、C、D、E组小鼠咽后壁接种PM标准品SRM1649a混悬液(浓度分别为0.09、0.52、1.85、69.2μg/μl).于自动分娩发生时剖宫取胎,观察孕鼠体质量、妊娠天数、仔鼠宫内存活及生长情况和肝、肺组织的病理改变,计算仔鼠肺及肝脏体系数,检测仔鼠肺CYP1A1、肝CYP1A2蛋白及mRNA的表达.结果 (1)各组孕鼠均未出现自然死亡.各组孕鼠妊娠1、7 d时体质量比较,差异均无统计学意义(P＞0.05);妊娠至14、18 d时,E组孕鼠体质量[分别为(41.8±5.8)及(48.9±8.9)g]明显低于A组[分别为(45.9±1.8)及(56.2±4.9)g],差异均有统计学意义(P＜0.05).E组孕鼠妊娠天数[(19.3±1.3)d]也明显低于A组[(20.5±0.7)d],差异有统计学意义(P＜0.05);A、B、C、D组孕鼠间妊娠天数分别比较,差异均无统计学意义(P＞0.05).各组仔鼠肺体系数及肝体系数比较,E组孕鼠[(1.21±0.18)及(4.68±0.21)%]高于A、B、C及D组,且差异均有统计学意义(P＜0.05).(2)E组仔鼠的死亡率(23.0%)高于A(0.8%)、B(0.9%)、C(1.7%)及D组(3.7%),差异均有统计学意义(P＜0.05);A、B、C、D组仔鼠的死亡率依次升高,但差异无统计学意义(P＞0.05).(3)E组仔鼠肝、肺病理改变显著,肝脏特征性病理改变包括肝组织结构紊乱、肝细胞浊肿、胞质淡染;多数肝细胞胞质内出现脂肪变性,部分肝细胞固缩,胞质深染;肝组织内见炎细胞浸润和点灶状坏死.肺特征性病理改变包括肺细支气管管腔变窄、黏膜下层小血管充血;间质、肺泡水肿,肺泡间隔增厚,泡内、细支气管周中性粒细胞及淋巴细胞浸润.C、D组上述病变程度次之,A、B组正常或变化轻微.(4)E组仔鼠肺CYP1A1和肝CYP1A2蛋白表达水平(分别为1.20±0.40及2.55±0.89)高于A组(0.77±0.36及2.08±0.31),两组比较,差异有统计学意义(P＜0.05).肺CYP1A1 mRNA表达,C(0.36±0.12)、D(0.41±0.08)、E组(0.43±0.11)高于A组(0.21±0.10),D、E组高于B组(0.28±0.10),分别比较,差异均有统计学意义(P＜0.05).肝CYP1A2 mRNA表达,C(0.37±0.13)、D(0.36±0.14)、E组(0.43±0.16)高于A组(0.21±0.03),E组高于B组(0.24±0.11),分别比较,差异均有统计学意义(P＜0.05).结论 PM具有胚胎毒性作用.超大剂量PM亚急性暴露可导致小鼠的不良妊娠结局;中、高剂量PM暴露可导致癌相关基因CYP1 A1和CYP1 A2表达的上调,可能对个体的后期发育有潜在的不良效应.

Abstract：

Objective To investigate subacute exposure of airborne particulate matter (PM) on pregnancy and fetal development in female mice. Methods Forty female and forty male ICR adult mice group (A), small (B) , middle (C) , large (D) or overdose (E) PM challenge groups (n = 8 - 11), and were administered with 30 μl of phosphate buffered solution (A) or resuspended standard PM SRM 1649a at 0.09 (B), 0.52 (C), 1.85 (D) or 69.2 (E) μg/μl, once per trid from d 0 till d 19 of pregnancy via instillation onto the base of the tongue. Fetal mice were harvested by cesarean section at the time when spontaneous delivery occurred. Body weight of the pregnant mice, gestational days, intrauterine survival and growth, hepatic and pneumonic histopathological changes of the fetal mice were investigated. Lung/body and liver/body weight ratios were calculated. Expressions of mRNA and protein of CYP1A1 in the fetal lung and CYP1 A2 in the fetal liver were assayed. Results (1) All of the pregnant mice survived pregnancy throughout the entire experiment. Body weight of the pregnant mice was not significantly different among all the groups at gestational d 1 and 7 (P ＞ 0.05), but significantly lower in group E [(41.8 ± 5.8) and (48.9 ± 8.9) g] than in group A [(45.9 ± 1.8) and (56.2 ± 4.9) g] at gestational d 14 and 18 (P ＜0.05). The gestational days were significantly decreased in group E [(19.3 ± 1.3) d] when compared with group A [(20.5 ± 0.7) d; P ＜ 0.05] and were not significantly different among groups A, B, C and D (P ＞ 0.05). Lung/body and liver/body weight ratios of the fetal mice were significantly increased in group E [(1.21 ±0.18) and (4.68 ±0.21)%] as compared with groups A, B, C and D (P＜0.05). (2)Mortality rates of the fetuses were significantly higher in group E (23.0%) than in groups A (0.8%), B (0.9%), C (1.7%) and D (3.7%) (P ＜ 0.05), but were not significantly different among groups A,B, C and D (P ＞ 0.05) despite of an increasing tendency. (3) Pathological changes in the liver and lung of the fetuses were conspicuous in group E. The fetal liver injury was histopathologically evidenced by deranged tissue structure, degenerated parenchyma of hepatic cells, and mildly stained cytoplasm. Adipose degeneration was represented by clear-boundary intracytoplasmic vacuoles in most of the liver cells, and cell pyknosis with heavily stained cytoplasm was observed in some of the liver cells. Inflammatory cell infiltration and focal necrosis were occasionally found in the hepatic tissue. The fetal lung exhibited bronchiole with narrow lumina, vascular engorgement in the submucosal layer, interstitial and alveolar edema, thickened alveolar septum, granulocyte and lymphocyte infiltrations within the pulmonary alveoli and around the bronchioles. The above pathological changes were lesser in groups C and D, and were not or least found in groups A and B. (4) Protein expressions of CYP1A1 in the fetal lung and CYP1A2 in the fetal liver were significantly increased in group E (1.20 ± 0.40 and 2.55 ± 0.89) when compared with group A (0.77 ±0.36 and 2.08 ±0.31) (P ＜ 0.05). mRNA expressions of CYP1A1 in the fetal lung were significantly increased in groups C (0.36 ±0.12), D (0.41 ±0.08) and E (0.43 ±0.11) compared with group A (0.21 ±0.10), and significantly increased in groups D and E compared with group B (0.28 ±0.10,P＜0.05). mRNA expressions of CYP1 A2 in the fetal liver were significantly increased in groups C (0.37 ±0.13), D (0.36 ±0.14) and E (0.43 ±0.16) compared with group A (0.21 ±0.03), and significantly increased in group E compared with group B (0.24± 0.11, P ＜ 0.05). Conclusions PM elicited embryotoxigenicity and resulted in adverse pregnancy outcomes in mice by intrauterine exposure of overdose PM. The expressions of cancer-related genes CYP1A1 and CYP1A2 were up-regulated in organs after the middle- and large-dose subacute exposure of PM, which may have a potential role on the future development.     

"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.     

腹腔镜下保留盆腔植物神经的解剖性广泛性子宫切除术37例临床分析

Objective To investigate feasibility of laparoscopic anatomical nerve sparing radical hysterectomy (LANSRH) used for locally advanced cervical cancer treatment and evaluate early recovery of bladder function postoperatively. Methods From October 2006 to September 2007, 37 cervical cancer patients with stage Ⅰb1 to Ⅱ a underwent LANSRH(LANSRH group) with pelvic lymphadenectomy matched 25 patients with cervical cancer treated by general laparoscopic radical hysterectomy (LRH,LRH group) with pelvic lymphadenectomy. The data of operating time, blood loss, numbers of lymph node, the length of resected vaginal and paracervix tissue were collected and compared. In the mean time, postoperative recovery of bladder function was evaluated. Results The laparoscopic anatomic nerve-sparing procedure was performed successfully and safely among all patients. (1) There was no remarkable difference in the following clinical parameters between LANSRH and LRH group: median operating time [(175±41) min vs. (178±30) min, P=0.72 ], blood loss [(233±104)ml vs. (218±77) ml, P=0.06], numbers of lymph nodes (13±4 vs. 15±6, P=0.16), resected length of paracervix tissue [(3.6±0.5)cm vs. (3.7±0.6) cm, P=0.43], resected length of vaginal tissue [(3.5±1.0)cm vs. (3.5±0.8) cm, P=0.80]. (2) The mean time of the Foley catheter removed was (10.6±2.7)days(7-17 days)in LANSRH group and (17.2±4.2)days(9-25 days)in LRH group (P=0.02). After Foley catheter removed, 95% (35/37) presented bladder fulfilling sense, 86% (32/37) presented automatic micturition and urination emptying in LANSRH group. However, In LRH group, 88% (22/25) presented bladder fulfilling sense, 76% (19/25) presented automatic micturition and urination emptying. The bladder void function recovery were 68% (25/37) in class 0 and 3% (1/37) in class Ⅱ in LANSRH group, when compared with 40% (10/25) in class 0 and 12% (3/25) in class Ⅱ in LRH group, it reached statistical difference (P<0.05). In the mean time, there was no significant difference in Class Ⅰ bladder void function recovery, which were 24% (9/37) and 48% (12/25). (3) No surgery complications and blood transfusion were observed in LANSRH and LRH group. Postoperative pathology suggested that no tumor cell invasion occurred in paracervix tissue and lymph nodes. During the range of 11 to 19 months follow-up, all patients were alive without tumor recurrence and metastasis. Conclusion LANSRH is safe and feasible surgical management for cervical cancer at early stage and would improve the recovery of bladder voiding function postoperatively by sparing anatomical nerve.     

腹腔镜下保留盆腔植物神经的解剖性广泛性子宫切除术37例临床分析

Objective To investigate feasibility of laparoscopic anatomical nerve sparing radical hysterectomy (LANSRH) used for locally advanced cervical cancer treatment and evaluate early recovery of bladder function postoperatively. Methods From October 2006 to September 2007, 37 cervical cancer patients with stage Ⅰb1 to Ⅱ a underwent LANSRH(LANSRH group) with pelvic lymphadenectomy matched 25 patients with cervical cancer treated by general laparoscopic radical hysterectomy (LRH,LRH group) with pelvic lymphadenectomy. The data of operating time, blood loss, numbers of lymph node, the length of resected vaginal and paracervix tissue were collected and compared. In the mean time, postoperative recovery of bladder function was evaluated. Results The laparoscopic anatomic nerve-sparing procedure was performed successfully and safely among all patients. (1) There was no remarkable difference in the following clinical parameters between LANSRH and LRH group: median operating time [(175±41) min vs. (178±30) min, P=0.72 ], blood loss [(233±104)ml vs. (218±77) ml, P=0.06], numbers of lymph nodes (13±4 vs. 15±6, P=0.16), resected length of paracervix tissue [(3.6±0.5)cm vs. (3.7±0.6) cm, P=0.43], resected length of vaginal tissue [(3.5±1.0)cm vs. (3.5±0.8) cm, P=0.80]. (2) The mean time of the Foley catheter removed was (10.6±2.7)days(7-17 days)in LANSRH group and (17.2±4.2)days(9-25 days)in LRH group (P=0.02). After Foley catheter removed, 95% (35/37) presented bladder fulfilling sense, 86% (32/37) presented automatic micturition and urination emptying in LANSRH group. However, In LRH group, 88% (22/25) presented bladder fulfilling sense, 76% (19/25) presented automatic micturition and urination emptying. The bladder void function recovery were 68% (25/37) in class 0 and 3% (1/37) in class Ⅱ in LANSRH group, when compared with 40% (10/25) in class 0 and 12% (3/25) in class Ⅱ in LRH group, it reached statistical difference (P<0.05). In the mean time, there was no significant difference in Class Ⅰ bladder void function recovery, which were 24% (9/37) and 48% (12/25). (3) No surgery complications and blood transfusion were observed in LANSRH and LRH group. Postoperative pathology suggested that no tumor cell invasion occurred in paracervix tissue and lymph nodes. During the range of 11 to 19 months follow-up, all patients were alive without tumor recurrence and metastasis. Conclusion LANSRH is safe and feasible surgical management for cervical cancer at early stage and would improve the recovery of bladder voiding function postoperatively by sparing anatomical nerve.     

腹腔镜下保留盆腔植物神经的解剖性广泛性子宫切除术37例临床分析

Objective To investigate feasibility of laparoscopic anatomical nerve sparing radical hysterectomy (LANSRH) used for locally advanced cervical cancer treatment and evaluate early recovery of bladder function postoperatively. Methods From October 2006 to September 2007, 37 cervical cancer patients with stage Ⅰb1 to Ⅱ a underwent LANSRH(LANSRH group) with pelvic lymphadenectomy matched 25 patients with cervical cancer treated by general laparoscopic radical hysterectomy (LRH,LRH group) with pelvic lymphadenectomy. The data of operating time, blood loss, numbers of lymph node, the length of resected vaginal and paracervix tissue were collected and compared. In the mean time, postoperative recovery of bladder function was evaluated. Results The laparoscopic anatomic nerve-sparing procedure was performed successfully and safely among all patients. (1) There was no remarkable difference in the following clinical parameters between LANSRH and LRH group: median operating time [(175±41) min vs. (178±30) min, P=0.72 ], blood loss [(233±104)ml vs. (218±77) ml, P=0.06], numbers of lymph nodes (13±4 vs. 15±6, P=0.16), resected length of paracervix tissue [(3.6±0.5)cm vs. (3.7±0.6) cm, P=0.43], resected length of vaginal tissue [(3.5±1.0)cm vs. (3.5±0.8) cm, P=0.80]. (2) The mean time of the Foley catheter removed was (10.6±2.7)days(7-17 days)in LANSRH group and (17.2±4.2)days(9-25 days)in LRH group (P=0.02). After Foley catheter removed, 95% (35/37) presented bladder fulfilling sense, 86% (32/37) presented automatic micturition and urination emptying in LANSRH group. However, In LRH group, 88% (22/25) presented bladder fulfilling sense, 76% (19/25) presented automatic micturition and urination emptying. The bladder void function recovery were 68% (25/37) in class 0 and 3% (1/37) in class Ⅱ in LANSRH group, when compared with 40% (10/25) in class 0 and 12% (3/25) in class Ⅱ in LRH group, it reached statistical difference (P<0.05). In the mean time, there was no significant difference in Class Ⅰ bladder void function recovery, which were 24% (9/37) and 48% (12/25). (3) No surgery complications and blood transfusion were observed in LANSRH and LRH group. Postoperative pathology suggested that no tumor cell invasion occurred in paracervix tissue and lymph nodes. During the range of 11 to 19 months follow-up, all patients were alive without tumor recurrence and metastasis. Conclusion LANSRH is safe and feasible surgical management for cervical cancer at early stage and would improve the recovery of bladder voiding function postoperatively by sparing anatomical nerve.     

腹腔镜下保留盆腔植物神经的解剖性广泛性子宫切除术37例临床分析

Objective To investigate feasibility of laparoscopic anatomical nerve sparing radical hysterectomy (LANSRH) used for locally advanced cervical cancer treatment and evaluate early recovery of bladder function postoperatively. Methods From October 2006 to September 2007, 37 cervical cancer patients with stage Ⅰb1 to Ⅱ a underwent LANSRH(LANSRH group) with pelvic lymphadenectomy matched 25 patients with cervical cancer treated by general laparoscopic radical hysterectomy (LRH,LRH group) with pelvic lymphadenectomy. The data of operating time, blood loss, numbers of lymph node, the length of resected vaginal and paracervix tissue were collected and compared. In the mean time, postoperative recovery of bladder function was evaluated. Results The laparoscopic anatomic nerve-sparing procedure was performed successfully and safely among all patients. (1) There was no remarkable difference in the following clinical parameters between LANSRH and LRH group: median operating time [(175±41) min vs. (178±30) min, P=0.72 ], blood loss [(233±104)ml vs. (218±77) ml, P=0.06], numbers of lymph nodes (13±4 vs. 15±6, P=0.16), resected length of paracervix tissue [(3.6±0.5)cm vs. (3.7±0.6) cm, P=0.43], resected length of vaginal tissue [(3.5±1.0)cm vs. (3.5±0.8) cm, P=0.80]. (2) The mean time of the Foley catheter removed was (10.6±2.7)days(7-17 days)in LANSRH group and (17.2±4.2)days(9-25 days)in LRH group (P=0.02). After Foley catheter removed, 95% (35/37) presented bladder fulfilling sense, 86% (32/37) presented automatic micturition and urination emptying in LANSRH group. However, In LRH group, 88% (22/25) presented bladder fulfilling sense, 76% (19/25) presented automatic micturition and urination emptying. The bladder void function recovery were 68% (25/37) in class 0 and 3% (1/37) in class Ⅱ in LANSRH group, when compared with 40% (10/25) in class 0 and 12% (3/25) in class Ⅱ in LRH group, it reached statistical difference (P<0.05). In the mean time, there was no significant difference in Class Ⅰ bladder void function recovery, which were 24% (9/37) and 48% (12/25). (3) No surgery complications and blood transfusion were observed in LANSRH and LRH group. Postoperative pathology suggested that no tumor cell invasion occurred in paracervix tissue and lymph nodes. During the range of 11 to 19 months follow-up, all patients were alive without tumor recurrence and metastasis. Conclusion LANSRH is safe and feasible surgical management for cervical cancer at early stage and would improve the recovery of bladder voiding function postoperatively by sparing anatomical nerve.     

腹腔镜下保留盆腔植物神经的解剖性广泛性子宫切除术37例临床分析

Objective To investigate feasibility of laparoscopic anatomical nerve sparing radical hysterectomy (LANSRH) used for locally advanced cervical cancer treatment and evaluate early recovery of bladder function postoperatively. Methods From October 2006 to September 2007, 37 cervical cancer patients with stage Ⅰb1 to Ⅱ a underwent LANSRH(LANSRH group) with pelvic lymphadenectomy matched 25 patients with cervical cancer treated by general laparoscopic radical hysterectomy (LRH,LRH group) with pelvic lymphadenectomy. The data of operating time, blood loss, numbers of lymph node, the length of resected vaginal and paracervix tissue were collected and compared. In the mean time, postoperative recovery of bladder function was evaluated. Results The laparoscopic anatomic nerve-sparing procedure was performed successfully and safely among all patients. (1) There was no remarkable difference in the following clinical parameters between LANSRH and LRH group: median operating time [(175±41) min vs. (178±30) min, P=0.72 ], blood loss [(233±104)ml vs. (218±77) ml, P=0.06], numbers of lymph nodes (13±4 vs. 15±6, P=0.16), resected length of paracervix tissue [(3.6±0.5)cm vs. (3.7±0.6) cm, P=0.43], resected length of vaginal tissue [(3.5±1.0)cm vs. (3.5±0.8) cm, P=0.80]. (2) The mean time of the Foley catheter removed was (10.6±2.7)days(7-17 days)in LANSRH group and (17.2±4.2)days(9-25 days)in LRH group (P=0.02). After Foley catheter removed, 95% (35/37) presented bladder fulfilling sense, 86% (32/37) presented automatic micturition and urination emptying in LANSRH group. However, In LRH group, 88% (22/25) presented bladder fulfilling sense, 76% (19/25) presented automatic micturition and urination emptying. The bladder void function recovery were 68% (25/37) in class 0 and 3% (1/37) in class Ⅱ in LANSRH group, when compared with 40% (10/25) in class 0 and 12% (3/25) in class Ⅱ in LRH group, it reached statistical difference (P<0.05). In the mean time, there was no significant difference in Class Ⅰ bladder void function recovery, which were 24% (9/37) and 48% (12/25). (3) No surgery complications and blood transfusion were observed in LANSRH and LRH group. Postoperative pathology suggested that no tumor cell invasion occurred in paracervix tissue and lymph nodes. During the range of 11 to 19 months follow-up, all patients were alive without tumor recurrence and metastasis. Conclusion LANSRH is safe and feasible surgical management for cervical cancer at early stage and would improve the recovery of bladder voiding function postoperatively by sparing anatomical nerve.     

腹腔镜下保留盆腔植物神经的解剖性广泛性子宫切除术37例临床分析

Objective To investigate feasibility of laparoscopic anatomical nerve sparing radical hysterectomy (LANSRH) used for locally advanced cervical cancer treatment and evaluate early recovery of bladder function postoperatively. Methods From October 2006 to September 2007, 37 cervical cancer patients with stage Ⅰb1 to Ⅱ a underwent LANSRH(LANSRH group) with pelvic lymphadenectomy matched 25 patients with cervical cancer treated by general laparoscopic radical hysterectomy (LRH,LRH group) with pelvic lymphadenectomy. The data of operating time, blood loss, numbers of lymph node, the length of resected vaginal and paracervix tissue were collected and compared. In the mean time, postoperative recovery of bladder function was evaluated. Results The laparoscopic anatomic nerve-sparing procedure was performed successfully and safely among all patients. (1) There was no remarkable difference in the following clinical parameters between LANSRH and LRH group: median operating time [(175±41) min vs. (178±30) min, P=0.72 ], blood loss [(233±104)ml vs. (218±77) ml, P=0.06], numbers of lymph nodes (13±4 vs. 15±6, P=0.16), resected length of paracervix tissue [(3.6±0.5)cm vs. (3.7±0.6) cm, P=0.43], resected length of vaginal tissue [(3.5±1.0)cm vs. (3.5±0.8) cm, P=0.80]. (2) The mean time of the Foley catheter removed was (10.6±2.7)days(7-17 days)in LANSRH group and (17.2±4.2)days(9-25 days)in LRH group (P=0.02). After Foley catheter removed, 95% (35/37) presented bladder fulfilling sense, 86% (32/37) presented automatic micturition and urination emptying in LANSRH group. However, In LRH group, 88% (22/25) presented bladder fulfilling sense, 76% (19/25) presented automatic micturition and urination emptying. The bladder void function recovery were 68% (25/37) in class 0 and 3% (1/37) in class Ⅱ in LANSRH group, when compared with 40% (10/25) in class 0 and 12% (3/25) in class Ⅱ in LRH group, it reached statistical difference (P<0.05). In the mean time, there was no significant difference in Class Ⅰ bladder void function recovery, which were 24% (9/37) and 48% (12/25). (3) No surgery complications and blood transfusion were observed in LANSRH and LRH group. Postoperative pathology suggested that no tumor cell invasion occurred in paracervix tissue and lymph nodes. During the range of 11 to 19 months follow-up, all patients were alive without tumor recurrence and metastasis. Conclusion LANSRH is safe and feasible surgical management for cervical cancer at early stage and would improve the recovery of bladder voiding function postoperatively by sparing anatomical nerve.     

腹腔镜下保留盆腔植物神经的解剖性广泛性子宫切除术37例临床分析

Objective To investigate feasibility of laparoscopic anatomical nerve sparing radical hysterectomy (LANSRH) used for locally advanced cervical cancer treatment and evaluate early recovery of bladder function postoperatively. Methods From October 2006 to September 2007, 37 cervical cancer patients with stage Ⅰb1 to Ⅱ a underwent LANSRH(LANSRH group) with pelvic lymphadenectomy matched 25 patients with cervical cancer treated by general laparoscopic radical hysterectomy (LRH,LRH group) with pelvic lymphadenectomy. The data of operating time, blood loss, numbers of lymph node, the length of resected vaginal and paracervix tissue were collected and compared. In the mean time, postoperative recovery of bladder function was evaluated. Results The laparoscopic anatomic nerve-sparing procedure was performed successfully and safely among all patients. (1) There was no remarkable difference in the following clinical parameters between LANSRH and LRH group: median operating time [(175±41) min vs. (178±30) min, P=0.72 ], blood loss [(233±104)ml vs. (218±77) ml, P=0.06], numbers of lymph nodes (13±4 vs. 15±6, P=0.16), resected length of paracervix tissue [(3.6±0.5)cm vs. (3.7±0.6) cm, P=0.43], resected length of vaginal tissue [(3.5±1.0)cm vs. (3.5±0.8) cm, P=0.80]. (2) The mean time of the Foley catheter removed was (10.6±2.7)days(7-17 days)in LANSRH group and (17.2±4.2)days(9-25 days)in LRH group (P=0.02). After Foley catheter removed, 95% (35/37) presented bladder fulfilling sense, 86% (32/37) presented automatic micturition and urination emptying in LANSRH group. However, In LRH group, 88% (22/25) presented bladder fulfilling sense, 76% (19/25) presented automatic micturition and urination emptying. The bladder void function recovery were 68% (25/37) in class 0 and 3% (1/37) in class Ⅱ in LANSRH group, when compared with 40% (10/25) in class 0 and 12% (3/25) in class Ⅱ in LRH group, it reached statistical difference (P<0.05). In the mean time, there was no significant difference in Class Ⅰ bladder void function recovery, which were 24% (9/37) and 48% (12/25). (3) No surgery complications and blood transfusion were observed in LANSRH and LRH group. Postoperative pathology suggested that no tumor cell invasion occurred in paracervix tissue and lymph nodes. During the range of 11 to 19 months follow-up, all patients were alive without tumor recurrence and metastasis. Conclusion LANSRH is safe and feasible surgical management for cervical cancer at early stage and would improve the recovery of bladder voiding function postoperatively by sparing anatomical nerve.     

腹腔镜下保留盆腔植物神经的解剖性广泛性子宫切除术37例临床分析

Objective To investigate feasibility of laparoscopic anatomical nerve sparing radical hysterectomy (LANSRH) used for locally advanced cervical cancer treatment and evaluate early recovery of bladder function postoperatively. Methods From October 2006 to September 2007, 37 cervical cancer patients with stage Ⅰb1 to Ⅱ a underwent LANSRH(LANSRH group) with pelvic lymphadenectomy matched 25 patients with cervical cancer treated by general laparoscopic radical hysterectomy (LRH,LRH group) with pelvic lymphadenectomy. The data of operating time, blood loss, numbers of lymph node, the length of resected vaginal and paracervix tissue were collected and compared. In the mean time, postoperative recovery of bladder function was evaluated. Results The laparoscopic anatomic nerve-sparing procedure was performed successfully and safely among all patients. (1) There was no remarkable difference in the following clinical parameters between LANSRH and LRH group: median operating time [(175±41) min vs. (178±30) min, P=0.72 ], blood loss [(233±104)ml vs. (218±77) ml, P=0.06], numbers of lymph nodes (13±4 vs. 15±6, P=0.16), resected length of paracervix tissue [(3.6±0.5)cm vs. (3.7±0.6) cm, P=0.43], resected length of vaginal tissue [(3.5±1.0)cm vs. (3.5±0.8) cm, P=0.80]. (2) The mean time of the Foley catheter removed was (10.6±2.7)days(7-17 days)in LANSRH group and (17.2±4.2)days(9-25 days)in LRH group (P=0.02). After Foley catheter removed, 95% (35/37) presented bladder fulfilling sense, 86% (32/37) presented automatic micturition and urination emptying in LANSRH group. However, In LRH group, 88% (22/25) presented bladder fulfilling sense, 76% (19/25) presented automatic micturition and urination emptying. The bladder void function recovery were 68% (25/37) in class 0 and 3% (1/37) in class Ⅱ in LANSRH group, when compared with 40% (10/25) in class 0 and 12% (3/25) in class Ⅱ in LRH group, it reached statistical difference (P<0.05). In the mean time, there was no significant difference in Class Ⅰ bladder void function recovery, which were 24% (9/37) and 48% (12/25). (3) No surgery complications and blood transfusion were observed in LANSRH and LRH group. Postoperative pathology suggested that no tumor cell invasion occurred in paracervix tissue and lymph nodes. During the range of 11 to 19 months follow-up, all patients were alive without tumor recurrence and metastasis. Conclusion LANSRH is safe and feasible surgical management for cervical cancer at early stage and would improve the recovery of bladder voiding function postoperatively by sparing anatomical nerve.     

子宫主韧带弹性蛋白、赖氨酰氧化酶和弹性蛋白酶抑制剂基因表达与盆腔器官脱垂发生的关系

目的 探讨子宫主韧带中弹性蛋白、赖氨酰氧化酶和弹性蛋白酶抑制剂基因表达变化与盆腔器官脱垂(POP)发生、发展的关系.方法 选择因子宫脱垂而行子宫全切除术的患者60例(POP组),其中绝经前27例,绝经后33例;选择同期因妇科良性疾病、无压力性尿失禁或POP而行子宫全切除术的患者60例为对照组,其中绝经前42例,绝经后18例.于手术中取子宫主韧带,采用RT-PCR技术检测弹性蛋白、赖氨酰氧化酶和弹性蛋白酶抑制剂mRNA的表达,免疫组化蛋白印迹法检测3种基因的蛋白表达.结果 (1)弹性蛋白mRNA及蛋白表达:POP组患者绝经前、后子宫主韧带弹性蛋白mRNA的表达分别为0.42±0.22、0.26±0.20,子宫主韧带弹性蛋白的蛋白表达分别为0.44±0.32、0.20±0.19;对照组患者绝经前、后子宫主韧带弹性蛋白mRNA的表达分别为0.79±0.30、0.63±0.23,子宫主韧带弹性蛋白的蛋白表达分别为0.89±0.27、0.78±0.25,两组绝经前及绝经后患者子宫主韧带弹性蛋白mRNA及蛋白表达分别比较,差异均有统计学意义(P＜0.05).(2)赖氨酰氧化酶mRNA及蛋白表达:POP组患者绝经前、后赖氨酰氧化酶mRI~A的表达分别为0.37±0.18、0.20±0.14,赖氨酰氧化酶的蛋白表达分别为0.45±0.27、0.26±0.21,对照组患者绝经前、后子宫主韧带赖氨酰氧化酶mRNA表达分别为0.65±0.22、0.53±0.20,子宫主韧带赖氨酰氧化酶的蛋白表达分别为0.85±0.39、0.69±0.31,两组绝经前及绝经后患者子宫主韧带赖氨酰氧化酶mRNA及蛋白表达分别比较,差异均有统计学意义(P＜0.05).POP组患者绝经后子宫主韧带弹性蛋白、赖氨酰氧化酶mRNA及蛋白表达均明显低于绝经前患者(P＜0.05).(3)弹性蛋白酶抑制剂mRNA及蛋白表达:POP组患者绝经前、后子宫主韧带弹性蛋白酶抑制剂mRNA表达分别为1.33±0.35、1.47±0.37,子宫主韧带弹性蛋白酶抑制剂的蛋白表达分别为0.85±0.30、0.76±0.35,对照组患者绝经前、后子宫主韧带弹性蛋白酶抑制剂mRNA表达分别为0.62±0.25、0.55±0.24,子宫主韧带弹性蛋白酶抑制剂的蛋白表达分别为0.21±0.15、0.29±0.22,两组绝经前及绝经后患者子宫主韧带弹性蛋白酶抑制剂mRNA及蛋白表达分别比较,差异均有统计学意义(P＜0.05);POP组患者绝经前、后弹性蛋白酶抑制剂mRNA及蛋白表达比较,差异无统计学意义(P＞0.05).POP患者子宫主韧带弹性蛋白与赖氨酰氧化酶mRNA及蛋白表达量呈明显的直线正相关关系(r=0.9959、0.9708,P＜0.05),而弹性蛋白与弹性蛋白酶抑制剂mRNA及蛋白表达量无直线相关性(r=-0.0402、-0.0365,P＞0.05).结论 POP患者子宫主韧带弹性蛋白、赖氨酰氧化酶表达下调及弹性蛋白酶抑制剂表达上调,可能与POP发生有关.     

改良盆底重建术治疗盆腔器官脱垂的临床研究

目的:探讨改良盆底重建术治疗盆腔器官脱垂(POP)的临床实用性。方法:选取59例POP患者,其中19例采用改良盆底重建术(A组),20例采用阴式子宫全切除术+阴道前壁"斜拉桥"式修补术(B组);20例采用传统阴式子宫全切除术+阴道前壁修补术(C组)。比较3组患者的围手术期各项指标情况及术后复发、阴道深度、性生活保持情况及疼痛不适等并发症情况。结果:(1)3组患者的手术时间、术中出血量、术后病率、术后性生活保持率及术后随访主观复发率比较差异均无统计学意义(P0.05);3组的术后留置尿管时间及客观复发率两两比较差异均有统计学意义(P0.05),A组的留置尿管时间最短,C组的客观复发率较高。C组术后的平均阴道深度浅于A、B组,差异有统计学意义(P=0.000);但后两组比较差异无统计学意义。3组患者均无严重并发症发生。结论:3种术式均能短期内解决POP问题,改良盆底重建术术式简单易操作,可保持盆底结构及功能的完整性,短期内具有较好的疗效,但远期疗效尚待循证。     

改良盆底重建术治疗女性盆腔脏器脱垂的临床研究

目的:探讨改良盆底重建术和经阴道子宫切除术(TVH)+阴道前后壁修补术治疗盆腔脏器脱垂性疾病的临床意义。方法:回顾分析2005年6月～2008年2月60例盆腔脏器脱垂(POP)患者行改良盆底重建术(研究组)或TVH+阴道前后壁修补术(对照组)的疗效和并发症发生情况。研究组30例,包括研究1组TVH+改良盆底重建术20例,研究2组单行改良盆底重建术4例,研究3组子宫切除术后POP行改良盆底重建术6例;对照组30例。结果:(1)手术时间、术中出血量、平均住院时间,研究1组与对照组无明显差异(P>0.05);术后保留尿管时间、术后并发症发生率,研究组与对照组差异无显著性(P>0.05);(2)术后临床疗效比较:4组患者出院前测评POP-Q,分度均为0度或Ⅰ度。术后对照组阴道长度较术前明显缩短,研究组阴道长度则较术前无明显变化(P<0.05);(3)随访:术后随访平均8个月,研究组随访率100%,对照组随访率96.67%。POP-Q分度Ⅱ度及Ⅱ度以上判定为复发,研究组1例,复发率为3.33%,对照组5例复发(16.67%)(P<0.05);研究组3例出现性交不适,对照组7例诉性生活质量下降(P<0.05)。结论:TVH+阴道前后壁修补术和改良全盆底重建术均是治疗POP的有效方法。改良盆底重建术作为一种新术式,能更好地修补缺陷、实现结构重建和组织替代,其复发率低,短期疗效稳定,长期疗效有待进一步观察。     

4种不同方案治疗绝经后萎缩性阴道炎疗效评价

目的:比较绝经后女性萎缩性阴道炎4种不同治疗方案的疗效及安全性,以指导临床诊疗。方法:选取在2016年11月—2018年8月就诊于新疆医科大学第一附属医院门诊的120例萎缩性阴道炎绝经妇女,根据纳入、排除标准将研究对象随机分为非雌激素药物(重组人源胶原蛋白阴道凝胶,薇润)治疗组(A组),雌激素药物(结合雌激素乳膏,红丽来)治疗组(B组),雌激素药物联合局部抗炎药(红丽来+保妇康泡沫剂)治疗组(C组),以及非雌激素药物联合局部抗炎药(薇润+保妇康泡沫剂)治疗组(D组),比较4组的疗效及安全性。结果:治疗后,4组阴道症状和体征评分分别为(7.59±1.28)分、(6.76±1.33)分、(4.48±1.02)分和(5.34±1.01)分,即疗效C组>D组>B组>A组,差异均有统计学意义(均P<0.05);4组阴道pH值分别为5.10±0.15、4.38±0.17、4.04±0.18和4.24±0.13,即疗效C组>D组>B组>A组,差异均有统计学意义(均P<0.05);4组阴道细胞成熟评分分别为(31.94±3.16)分、(65.68±2.44)分、(72.19±2.86)分和(54.40±2.56)分,A组治疗前后差异无统计学意义(P>0.05),其余3组治疗后均较治疗前明显增高,且疗效C组>B组>D组,差异均有统计学意义(均P<0.05)。在治疗安全性方面,4组不同治疗方案的患者子宫内膜厚度、血清雌二醇(E2)、卵泡刺激素(FSH)和黄体生成激素(LH)水平,治疗前后差异无统计学意义(均P>0.05)。结论:4种治疗方案对萎缩性阴道炎都有明显疗效,若有激素治疗禁忌者及拒绝激素治疗者可以使用非雌激素类药物联合局部抗炎药物作为有效替代方案。     

神经肽Y及其受体在盆腔器官脱垂患者主韧带和宫骶韧带上的表达及意义

目的 研究神经肽Y(NPY)及其受体NPY-Y1、Y2在盆腔器官脱垂(POP)患者主韧带和宫骶韧带上的分布、表达及意义.方法 选择POP患者16例,按盆腔器官脱垂定量(POP-Q)分度法分度,其中POP-Q分度法为Ⅰ、Ⅱ度者6例为A组,Ⅲ、Ⅳ度者10例为B组.选择无POP的卵巢非功能性肿瘤患者8例作为对照组.标本取自主韧带、宫骶韧带,经甲醛固定、石蜡包埋后切片,采用免疫组化法检测NPY的分布;采用RT-PCR技术检测NPY-Y1和Y2 mRNA的表达.结果 (1)NPY在主韧带、宫骶韧带上均有分布.与对照组比较,NPY在POP患者的主韧带和宫骶韧带上的分布有减少的趋势,但3组间比较,差异均无统计学意义(P＞0.05);NPY在各组患者自身主韧带和宫骶韧带上的分布情况比较,差异均无统计学意义(P＞0.05).(2)NPY-Y1和Y2 mRNA在主韧带、宫骶韧带中均有表达,并检测到NPY-Y1中97 bp的剪切变异体存在.(3)NPY-Y1 mRNA在主韧带上的表达,A组(3.9±1.0)与B组(6.0±1.5)之间,以及B组与对照组(3.4±0.9)之间比较,差异均有统计学意义(P=0.019,P=0.004);A组与对照组之间比较,差异无统计学意义(P=0.082).NPY-Y1 mRNA在宫骶韧带上的表达,A组(6.0±1.1)与B组(6.3±0.7)之间,以及A组与对照组(4.8±0.7)之间分别比较,差异均无统计学意义(P=0.151,P=0.690);B组与对照之间比较,差异有统计学意义(P=0.016).(4)NPY-Y2 mRNA在主韧带和宫骶韧带上的表达,A组(分别为0.56±0.21、0.67±0.13)、B组(分别为0.85±0.43、0.69±0.21)、对照组(分别为0.49±0.34、0.61±0.15)3组之间分别比较,差异均无统计学意义(P＞0.05).(5)NPY-Y1、Y2 mRNA在各组患者自身主韧带与宫骶韧带上的表达比较,差异均无统计学意义(P=0.084,P=0.470).结论 NPY及其受体在子宫主韧带及宫骶韧带上均有表达;NPY-Y1在主韧带及宫骶韧带上的表达水平显著升高,可能与局部血流减少、主要支持组织结构改变相关.     

二维超声在产后女性前腔室结构变化研究中的价值

目的运用二维超声评估产后女性在静息状态下前腔室结构的变化。方法收集顺产、剖宫产的产后患者共45例,作为产后组,运用二维超声评估静息状态下前腔室结构的变化,并与30例未育、无盆底功能障碍女性(对照组)的超声检查结果进行对比。结果静息状态下,产后组与对照组逼尿肌厚度、尿道内口漏斗形成率及膀胱后角大小差异无统计学意义(P0.05)。产后组尿道倾斜角度[(30.12±0.86)°]大于对照组[(18.89±0.40)°],膀胱颈位置[(26.75±0.32)mm]低于对照组[(29.67±0.91)mm],差异有统计学意义(P0.05)。顺产组与剖宫产组各项指标差异均无统计学意义(P0.05)。结论二维超声可初步了解分娩对女性前腔室结构的影响,但所能提供的信息有限。     

两种全盆底重建术后患者生活质量的初步研究

目的 观察两种全盆底重建术对患者生活质量的影响.方法 应用Prolift盆底悬吊系统行全盆底重建术14例(Prolift组),应用Gynemesh聚丙烯补片行改良全盆底重建术17例(Gynemesh组).两组患者体重指数、绝经年龄和孕次比较,差异无统计学意义(P＞0.05),Prolift组患者年龄[(63±9)岁]、产次[(1.9±1.1)次]均低于Gynemesh组[(69±5)岁、(3.1±1.1)次],差异均有统计学意义(P＜0.05).手术前后进行生活质量调查问卷评分.结果 (1)术前评分:Prolift组盆底功能影响评分为(91±42)分、盆底功能障碍评分为(100±59)分、性生活评分为(77±26)分;Gynernesh组盆底功能影响评分为(65±56)分、盆底功能障碍评分为(89±73)分、性生活评分为(75±18)分,两组各项评分比较,差异均无统计学意义(P＞0.05);(2)术后评分:Prolift组盆底功能影响评分为(7±15)分、盆底功能障碍评分为(27±24)分、性生活评分为(79±43)分,Gynemesh组盆底功能影响评分为(13±24)分、盆底功能障碍评分为(24±21)分、性生活评分为(74±15)分,两组各项评分比较,差异也无统计学意义(P＞0.05).结论 Prolift全盆底重建术和Gynemesh改良全盆底重建术术后的生活质量均有明显改善,而在术后性生活质量改善方面,Prolift全盆底重建术效果更好.     

盆腔器官脱垂患者阴道前壁组织中弹性蛋白和细胞外基质蛋白fibulin-5的表达及意义

目的 探讨盆腔器官脱垂(POP)患者阴道前壁组织中弹性蛋白和细胞外基质蛋白fibulin-5的表达变化及其临床意义.方法 选择中国医科大学附属盛京医院妇产科2006年11月至2008年6月诊断为POP并行手术治疗的68例患者的膨出阴道前壁组织(POP组).POP组患者依据POP定量分度(POP-Q)法,分为Ⅰ度10例、Ⅱ度21例、Ⅲ度25例、Ⅳ度12例.选择同期因宫颈鳞癌Ⅰ b期行子宫伞切除+双侧附件切除术的18例患者的阴道前壁切除组织石蜡标本作为对照组.免疫组化染色法检测两组阴道前壁组织中fibulin-5和弹性蛋白的表达.结果 (1)弹性蛋白和fibulin-5在阴道前壁组织中的表达主要定位于细胞外基质.(2)POP组患者阴道前壁组织中fibulin-5的阳性表达率为15%(10/68),低于对照组的44%(8/18),差异有统计学意义(P=0.010).POP组患者阴道前壁组织中fibulin-5的阳性表达率,POP-Q分度为Ⅲ、Ⅳ度者[5%(2/37)]低于Ⅰ、Ⅱ度者[26%(8/31)],差异有统计学意义(P=0.035);已绝经者[13%(8/60)]与未绝经者(2/8)比较,阴道分娩≤2次者[19%(5/27)]与＞2次者[12%(5/41)]比较,差异均无统计学意义(P＞0.05).(3)POP组患者阴道前壁组织中弹性蛋白的阳性表达率为31%(21/68),低于对照组的72%(13/18),差异有统计学意义(P=0.002).POP组患者阴道前壁组织中弹性蛋白的阳性表达率,POP-Q分度为Ⅲ、Ⅳ度者[19%(7/37)]低于Ⅰ、Ⅱ度者[45%(14/31)],差异有统计学意义(P=0. 034);已绝经者[30%(18/60)]与未绝经者(3/8)比较,阴道分娩≤2次者[26%(7/27)]与＞2次者[34%(14/41)]比较,差异均无统计学意义(P＞0.05).(4)POP组68例患者阴道前壁组织中,fibulin-5与弹性蛋白表达均为阳性者6例,均为阴性者43例,fibulin-5与弹件蛋白在POP组患者阴道前壁组织中的表达呈正相关关系(P=0.031).结论 POP患者盆底结缔组织中弹性蛋白和fibulin-5表达下降,并与POP严重程度相关.     

Midterm prospective comparison of vaginal repair with mesh vs Prolift system devices for prolapse

Objective

To compare midterm clinical outcome using modified pelvic floor reconstructive surgery with mesh (MPFR) vs Prolift devices for the treatment of pelvic organ prolapse (POP).

Study design

This prospective observational cohort study involved 223 women with POP stages III–IV who were assigned to either MPFR (n = 131) or Prolift device (n = 92). Outcomes were analyzed at 6 and 12 months and the last follow-up visit postoperatively. Main outcome measures included pelvic organ prolapse quantification measurement, Short Form-20 Pelvic Floor Distress Inventory (PFDI-20), Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ) questionnaires, perioperative outcomes, complications, and a personal interview about urinary and sexual symptoms. Statistical analysis included comparison of means (Wilcoxon test or Student's t-test) and proportions (Chi-square test). Multivariate analysis was carried out using Cox proportional hazard model.

Results

At follow-up (median, 36 months; range, 17–58 months), anatomic success for MPFR and Prolift was 87.07% and 93.41%, respectively (P = 0.1339). Both operations significantly improved quality of life, and PFDI-20 scores were lower in the Prolift group than the MPFR group (P = 0.03). Complication rates did not differ significantly between the two groups and the prevalence of urinary symptoms decreased postoperatively in both groups. The cost of operation, however, was RMB ¥11,882.86 yuan for MPFR and ¥23,617.59 yuan for Prolift (P = 0.00).

Conclusions

MPFR and Prolift had comparable anatomic outcomes, Prolift had better functional outcomes than MPFR, but MPFR is much cheaper than Prolift. MPFR is an alternative, cheap and effective surgical treatment option to mesh-kits for the management for POP.     

全盆底重建术与传统阴式修补术治疗重度盆腔器官脱垂的疗效比较

目的比较全盆底重建术与传统阴式子宫切除加阴道前后壁修补术在治疗重度盆腔器官脱垂（POP）中的临床疗效及对患者生活质量的影响。方法回顾性分析南京市妇幼保健院2008年1月至2009年12月收治的70例POP—QHI～Ⅳ期盆腔器官脱垂患者,并将其分为重建组（35例）和传统组（35例）。重建组采用全盆底重建术,其中14例患者因年纪较大,无保留子宫需求同时行阴式子宫切除术;传统组采用阴式子宫切除加阴道前后壁修补术。术后1个月、6个月、1年、2年进行随访,以盆底功能影响问卷简表（PFIQ-7）、盆底不适调查表简表（PFI）I-20）和POP-尿失禁性生活问卷（PISQ）评价手术疗效及对患者生活质量的影响。结果①重建组平均手术时间为（108．3 ±29．4）min,平均术中出血量为（192．3±72．9）ml,平均保留导尿管时间（3．8±1．1）d,平均术后住院时间为（7．1±1．5）d,传统组分别为（127．0±18．5）m_in、（251．4±56．2）rnl、（5．8±0．7）d和（9．O±2．4）d。以上各项指标两组比较,差异均有统计学意义（P〈O．05）。②两组均无失访病例。重建组术后2年复发率为0（0／35）,传统组为17．1％（6／35）,两组比较,差异有统计学意义（P〈0．05）。③重建组术前和术后2年PFIQ评分分别为（79．2±20．6）分和（3．9±5．2）分,传统组分别为（80．6±18．9）分和（20．4±12．8）分;重建组术前和术后2年PFDI评分分别为（73．7±17．1）分和（4．2±4．2）分,传统组分别为（78．2±19．1）分和（15．O±9．5）分,两组术后2年PFIQ和PFDI评分均较术前显著降低（P〈0．05）,且重建组术后2年PFIQ和PFDI评分均低于传统组（P〈O．05）。④重建组术前13例患者有性生活,其术前PISQ评分[（65．7±8．1）分]与术后2年[（64．7±7．3）分]比较,差异无统计学意义（P〉o．05）。传统组11例患者术前有性生活,术后9例患者由于手术原因拒绝性生活。结论与传统阴式手术比较,全盆底重建术复发率低,术后生活质量改善明显,对性生活影响小,值得临床推广。