传统修补、Prolift盆底重建系统和Gynemesh聚丙烯补片在全盆底重建术中的应用

目的 比较传统修补、Prolift盆底重建系统和Gynemesh聚丙烯补片在全盆底重建术中的应用情况。方法 回顾分析2009年3月至2011年3月间第二军医大学长海医院收治的40例盆腔脏器脱垂行全盆底重建术的患者资料。采用传统修补15例，Prolift盆底重建10例,Gynemesh聚丙烯补片行童式全盆底重建术15例。比较3组患者的一般资料、围手术期和随访情况,并进行统计学分析。结果 3组患者的体质量指数、平均年龄、绝经年龄和孕次比较,差异均无统计学意义(P>0.05)。3组患者阴道前壁脱垂、子宫脱垂和阴道后壁脱垂的程度差异无统计学意义(P>0.05)。3组患者术中出血量、最高体温、尿管留置天数、术后残余尿、手术时间和住院时间比较,差异无统计学意义(P>0.05)。Prolift组随访率100%,平均随访时间(5.8±2.0)个月,1例患者补片侵蚀, 1例患者出现轻度张力性尿失禁；Gynemesh组随访率93.3%,平均随访时间(9.1±2.0)个月,1例患者术后出现乳糜样腹水,1例前壁复发(POP-QⅡ期)；传统修补组随访率100%,平均随访时间(9.1±5.0)个月,阴道前、后壁复发各1例(POP-QⅡ期)。结论 传统修补、Prolift和Gynemesh补片均可用于全盆底重建,手术均安全可行。在近期疗效和并发症方面,3组间无明显差异。

Conventional repair, Prolift system and Gynemesh system in total pelvic floor reconstruction: a comparison

Objective To compare the conventional repair,Prolift system and Gynemesh system in total pelvic floor reconstruction.Methods Forty patients with pelvic organ prolapse(POP),who were treated in our department from March 2009 to March 2011,were included in the present study.Fifteen cases were in the conventional repair group,10 in the Prolift system surgery,and the other 15 in the Tongshi group(revised total pelvic floor construction with Gynemesh).The pre-,peri-operative data and follow-up results were compared between the 3 groups.Results The body mass index,menopause age,pregnant times and the degrees of prolapses were comparable in the 3 groups(P>0.05).The degrees of anterior and posterior vaginal proplase and uterus proplase were not significantly different between the 3 group(P>0.05).The intro-operative blood loss,highest body temperature,residual urine,operation time,and hospital stay were not significantly different between the 3 groups(P>0.05).The follow-up rate was 100% for the Prolift group,with a mean time of(5.8±2.0) months;one case developed erosion in the anterior vagina1 wall and one had Ⅰ stress urinary incontinence.The follow-up rate was 93.3% in the Gyenmesh group,with a mean time of(9.1±2.0) months;one case had chylous ascites after whole pelvis suspension and one had recurrent anterior vaginal proplase POP-Q Ⅱ.The follow-up rate was 100% in the classical group,with a mean time of(9.1±5.0) months;anterior and posterior vaginal proplase POP-Q Ⅱ were each found in one case.Conclusion Conventional repair,Prolift system and Gynemesh system are all safe and suitable for total pelvic floor reconstruction,and they have no difference concerning the short-term clinical outcomes and complications.