经阴网片全盆重建术治疗重度盆腔器官脱垂中长期临床疗效评价

目的 探讨经阴网片全盆重建手术治疗盆腔器官脱垂的疗效及并发症，评估该手术的有效性和安全性。方法 回顾性分析2007年1月至2014年6月在广州医科大学附属第一医院因盆腔器官脱垂行经阴网片全盆重建术110例患者的临床资料，比较手术前后盆腔器官脱垂定量分期法(POP-Q)各指示点位置，评价总体客观治愈率及复发率。采用盆底功能障碍性疾病症状问卷简表(PFDI-20)等相关问卷评分评价主观治愈率以及术后尿失禁相关症状改善情况。结果 110例患者中失访12例（12/110, 10.91%），其中1例因心血管疾病术后1年余死亡，随访98例（98/110, 89.09%）。随访时间6～90个月，中位随访时间：48个月。110例患者年龄(65.30±8.00)岁；绝经时间(14.01±9.08)年；采用POP-Q分期评价，术后15例（15/98，15.31%）出现复发，其中11例POP-Q分期Ⅱ期，无主观症状不需再次手术，4例阴道顶端复发（POP-Q Ⅲ期），需再次手术治疗。术后主观治愈率95.92%(94/98），客观治愈率84.69%(83/98）；网片挛缩4例（4/98， 4.08%），网片外露11例（11/98，11.22%）。术后PFDI-20评分与术前比较，差异有统计学意义(P<0.05)；术后性生活13例，其中性生活质量5例满意，6例患者较术前差，2例配偶出现性交疼痛；患者总体术后满意度评分满意率95.91%(94/98)。结论 经阴网片全盆重建术用于治疗重度盆腔器官脱垂主、客观治愈率高，不仅能达到较好的解剖学复位，对患者的盆腔器官脱垂相关症状有明显改善，术后满意度高且长期疗效稳定，但对性生活质量无明显改善。

Mid-term clinical efficacy evaluation of using transvaginal mesh repair systems for severe pelvic organ prolapse.

Abstract： Objective To study the efficacy of transvaginal mesh repair systems for severe pelvic organ prolapse, identify the complications of the surgery and to assess the effectiveness and safety. Methods A retrospective analysis was performed on the clinical data, from January 2007 to June 2014 in the First Affiliated Hospital of Guangzhou Medical University, in a total of 110 patients who did the total pelvic floor reconstruction due to severe pelvic organ prolapse, and a comparison was carried out between before and after the surgery on each indication point of the pelvic organ prolapse quantification (POP-Q) indexing, and an objective evaluation was made on the overall cure rate and recurrence rate. Pelvic floor dysfunction symptom questionnaire summary table (PFDI-20) and other relevant evaluation questionnaire scores were used to indicate subjective cure rate and improvement of symptoms. Results The 110 patients were followed up, and 98 patients (98/110, 89.09%) were reached. The other 12 patients (12/110, 10.91%) were lost in touch, including one patient passing away because of cardiovascular disease after 1-year follow-up. Follow-up time: 6-90 months,the median follow-up time: 48 months. The average age of the patients in 110 cases was (65.30 ± 8.00) years; mean menopause age was (14.01 ± 9.08) years.Fifteen patients (15.31%) had recurrence after surgery, including 11 patients diagnosed with POP-Q Ⅱ stage without surgery intervention and 4 cases of vaginal vault recurrence (POP-Q Ⅲ stage) which required reoperation. The subjective cure rate was 95.92% (94/98) and the objective cure rate is 84.69%