全盆底重建术治疗重度盆腔器官脱垂的近期疗效及安全性分析

目的探讨全盆底重建术治疗女性重度盆腔器官脱垂的近期疗效及安全性。方法回顾性分析湖北省十堰市太和医院2009年12月至2013年12月接受全盆底重建术治疗的重度盆腔器官脱垂56例患者的临床资料,术后定期随访,通过盆腔器官脱垂定量检查法(pelvic organ prolapse quantitation,POP–Q)分期评价解剖疗效,盆底功能影响问卷-简表7(pelvic floor impact questionnaire-7,PFIQ–7)、盆底功能障碍问卷-20(pelvic floor distress inventory-20,PFDI–20)和POP–尿失禁性生活问卷–12(pelvic organ prolapse/urinary incontinence sexual questionnaire-12,PISQ–12)三种生活质量和性生活问卷评价功能疗效,从而分析全盆底重建术的近期疗效及安全性。结果手术均进行顺利,术中术后均无输血,无直肠、膀胱、尿道、血管及神经等损伤。除1例术后尿潴留外,其余均1~2 d恢复自主排尿,近期并发症为1.7%(1/56)。2例网片侵蚀,远期并发症为3.5%(2/56)。术后1年主、客观治愈率均为100%。PFIQ–7和PFDI–20评分显示术后生活质量较术前显著提高(t分别=16.69、19.21,P=0.000),而性生活质量改善不大(t=0.124,P=0.613)。结论全盆底重建术用于纠正重度盆腔器官脱垂,手术安全、创伤小、解剖和功能恢复率高,复发率低,能显著改善患者的生活质量,对性生活质量影响不大,近期疗效及安全性肯定,值得临床上进一步推广。

Recent effectiveness and safety analysis of total pelvic reconstruction surgery for repair of severe pelvic organ prolapse

Objective To evaluate recent effectiveness and safety of total pelvic reconstruction surgery for repair of severe pelvic organ prolapse( POP) . Methods Analyzed the clinical data of 56 patients with severe POP in Shiyan Taihe Hospital of Hubei province from Dec. 2009 to Dec. 2013 retrospectively ,and the patients were followed regularly after surgery. The anatomical outcomes were evaluated by pelvic organ prolapse quantitation( POP-Q) , functional effectiveness by pelvic floor inpact questionnaire-7 ( PFIQ–7),pelvic floor distress inventory-20 (PFDI–20)and pelvic organ prolapse/urinary incontinence sexual questionnaire-12(PISQ–12) . Results All surgical operations were accomplished successfully. No patient required blood transfusion and no rectum,bladder, urethra, blood vessel and nerve was injuryed. Except one patient experienced postoperative urinary retention, and the remaining patients were able to micturate spontaneously 1~2 days after surgery. The recent postoperative morbidity rate was 1. 7% (1/56). Two patients experienced mesh erosion, the long-term postoperative morbidity rate was 3. 5%(2/56). After one year, the subjective and objective cure rate was 100%. Questionnaire scores showed that the overall postoperative quality of life was improved significantly ( t=16.69,19.21, P <0.05), while quality of sexual life insignificantly (t = 0.124,P > 0.05). Conclusion The total pelvic reconstruction surgery is a safe, small trauma, high rate of anatomical and functional recovery, low rate of the recurrence approach for the repair of severe POP. It is worth further clinical promotion, because of significant improvement of the patient's life quality, a little influence on the sex-life quality and the good recent curative effect and safety.