补片在盆腔器官脱垂全盆底重建术中应用的初步临床分析

目的初步探讨聚丙烯补片在全盆腔重建术治疗盆腔器官脱垂的效果及并发症。方法我院妇科在2006年12月～2007年9月期间，收治12例因盆腔多个部位缺陷的脏器脱垂患者行全盆底重建术。年龄56-79岁，平均年龄（70．7±6．51）岁；8例患者年龄在70岁以上，占66％。体重指数（23±2．5）。孕次4～7次，平均（3．9±1．7）次。产次1～7次，平均（3．0±1．50）次。子宫（穹隆）脱垂Ⅳ期1例，Ⅲ期4例，Ⅱ期3例，Ⅰ期3例，0期1例。阴道前壁脱垂Ⅳ期1例，Ⅲ期10例，Ⅱ期1例。阴道后壁脱垂Ⅳ期1例，Ⅲ期1例，Ⅱ期1例，Ⅰ期8例，0期1例。所有患者均同时存在两个或两个以上部位的缺陷。结果12例患者手术时间70～195min，平均为（115±40）min术中出血量（50±400）ml，平均为（188±113）ml。12例患者术后恢复较好，术后最高体温37．2～39．0℃，平均（38．0±0．54）℃．尿管留置时间3～8d，平均（5．20±1．3）d。术后测残余尿量0～95ml，平均（22±30）ml。住院天数10b14d，平均为（12±1．5）d。所有病例穿刺顺利，未见血肿、血管及脏器损伤。12例患者，随访率91％，1例因居住外地未随访。随访时间3～12个月，平均（6．3±3．0）月。11例患者未见脱垂复发。3例患者（25％）术后6周复查时发现有吊带侵蚀。结论应用Gynemesh聚丙烯补片行全盆底重建术治疗盆腔器官脱垂，方法可行，安全可靠，近期可出现补片侵蚀，远期疗效有待观察。

The application of mesh in female total pelvic reconstruction surgery

Objective To investigate the application of polypropylene mesh in female total pelvic reconstruction surgery. Methods Twelve patients admitted to our department underwent total pelvic reconstruction surgery from December 2006 to September 2007. Non - absorbable polypropylene mesh was used for pelvic floor reconstruction. The average age was 70. 7 （56-79） years old. The preoperative diagnosis were： one woman with uterine prolapse of stage Ⅳ;4 stage Ⅲ ; 3 stage Ⅱ; 3 stage Ⅰ ; one with anterior vaginal wall prolapse of stage Ⅳ;10 stage Ⅲ ;1 stage Ⅱ ; one case with posterior vaginal wall prolapse of stage Ⅳ, Ⅲ and Ⅱ, respectively; 8 with stage Ⅰ. All of the patient had more than two defects. Results The mean operation time was 115 min （70-195 min）. The mean blood loss was 188 ml （50-400 ml）. All patients recovered well after operation. No hematoma, vessel damage or infection occurred. The mean period of follow-up after operation was 6.3 months （3-12 months）. No recurrence was found. Three cases were found with erosion. Conclusions The application of polypropylene mesh in female total pelvic reconstruction surgery is safety. Erosion is a common complication for this surgery. The long - term outcome remains further study.