改良全盆底重建手术治疗女性盆腔器官脱垂35例疗效观察

目的评价改良盆底重建术治疗盆腔脏器脱垂的临床效果。方法盆腔脏器脱垂定量(POP-Q)分度为Ⅲ～Ⅳ度35例患者行改良盆底重建术,观察手术时间、术中出血量、住院时间等围手术期指标,以POP-Q分度为客观疗效评价指标,以临床症状消失为主观治愈指标。术后定期随访,观察疗效。结果手术平均时间(55士20.2)min、术中平均出血(100±40.2)ml,术后住院平均(4.5±1.5)d,术后随访3～18个月、中位随访时间6个月,客观治愈率94%(33/35),主观有效率91%(32/35)。术后仅1例发生网片侵蚀,3例发生排尿困难,2例发生性交痛,2例发生急迫性尿失禁。结论改良盆底重建术是治疗盆腔脏器脱垂的有效术式,保留子宫同时加强盆底组织,手术简单、安全、微创、经济,远期疗效有待进一步观察。

Modified total pelvic floor reconstruction in treatment of severe organ prolapse in 35 patients

Objective： To evaluate the effect of modified pelvic floor reconstruction on pelvic organ prolapse. Methods： Modified total pelvic floor reconstruction was performed, from Sep. 2007 to sept. 2009 in the hospital, on 35 patients with pelvic organ prolapse at stage of Ⅲ-Ⅳ, classified by the international pelvic organ prolapse staging system （POP-Q）. Operation time, blood loss during operation and length of hospital stay were recorded. Patients were followed up at 3, 6 and 12 months postoperation. Pelvic status and organ prolapse were evaluated with POP-Q system, and symptoms reported by patients. Results： The operation was successfully conducted in all patients, without any operation-related injure to internal organs. The mean operation time was 55±20.2 minutes, mean blood loss was 100±40.2 ml, and mean hospital stay was 4.5±1.5 days. The median follow-up was 6 months （3-18 months）. The pelvic organ prolapse, evaluated by POP-Q system, was totally relived in 33 （94.3%） patients and partially relived in the other two. One mesh erosion was observed 5 weeks after operation, and mended. Three patients reported dysuria, 2 experienced stress urinary incontinence and 2 complained dyspareunia, but recovered over time. Sexual activities were improved in all but two patients. No severe complications were found in any patients.
Conclusions： Modified pelvic floor reconstruction is a simple, safe, effective, economic and micro-in- vasive method for pelvic organ prolapse. Its long-term effect needs to be followed up.