Prolift网片联合尿道中段悬吊治疗POP或合并SUI患者的近期疗效

目的:探讨全阴道修复网片(total vaginal mesh,TVM)即Gynecare Prolift网片修复系统及联合经闭孔无张力阴道吊带(tensiongfree vaginal tape-obtutor,TVT-O)尿道中段悬吊手术治疗盆腔器官脱垂(pelvic organ prolapse,POP)或合并压力性尿失禁(stress urinary incontinence,SUI)的近期疗效。方法:选择Ⅱ度以上子宫和(或)阴道壁脱垂患者24例,其中本次手术前已切除子宫5例,术中同时切除子宫12例,保留子宫7例。16例用全盆底修复网片(total Prolift),8例用前盆修复网片(anterior Prolift);10例因合并压力性尿失禁同时行TVT-O尿道中段悬吊术。结果:24例患者术中均无严重并发症发生,3例(12.5%)出血量超过500ml;术后随访12～20个月,1例至术后10个月时发现阴道壁网片侵蚀(4.2%,1/24),经门诊4次修剪好转;24例患者均无复发。结论:用Prolift盆底修复网片系统进行盆底重建术,手术安全、易行、微创,近期疗效肯定;合并SUI者同时使用TVT-O不增加手术难度和并发症的发生率。

Curative effect of prolift and combining with suspensory midst urethra in surgery therapy on POP or concomitant SUI

Objective:To explore the innovative repairing technique and its curative effect of the total vaginal mesh system(Gynecare Prolift) and combining with suspensory midst urethra(tensiongfree vaginal tape-obtutor,TVT-O) in surgery therapy on pelvic organ prolapse(POP) and concomitant stress urinary incontinence(SUI).Method:24 cases with stage Ⅱ or more severe genital prolapse on the pelvic organ prolapse quantification examination(POP-Q) were enrolled.5 in 24 cases had a previous hysterectomy,12 in 24 cases with transvaginal hysterectomy and 7 in 24 cases preserving uterus.All the 24 cases underwent transvaginal repair by using total vaginal meshes(total Prolift)(16/24) and isolated anterior meshes(anterior Prolift)(8/24) and 10 cases thereinto,who suffered from stress urinary incontinence,with tension-free vaginal tape-obturator system(TVT-O) procedure simultaneously.Result:There were no severe intraoperative complications in all 24 cases,but 3 cases of them(12.5%) being blood loss more than 500ml.All the cases were followed up for 12 to 20 months.The vaginal wall erosion had been found in one of 24 cases(4.2%) in the 10th months after operation,no severe vaginal infection,recurrent and symptomatic prolapse were occurred in postoperatively short-term.Conclusion:The total transvaginal mesh system is considered as a safe,simple,mini-invasive,and efficient surgery therapy on POP in short term.The complication and operative difficulty,procedure of Gynecare Prolift and combining it with suspensory midst urethra(tensiongfree vaginal tape-obtutor,TVT-O),is not increased for the POP and concomitant SUI.Nevertheless,long-term safety and efficacy should be further observed.