全盆底网片悬吊术治疗老年女性盆腔器官脱垂184例的疗效

目的评估自创的保留子宫的全盆底悬吊术治疗老年女性盆腔器官脱垂的有效性和安全性。方法对184例有不同缺陷的女性盆腔器官脱垂的老年患者行全盆底悬吊术,应用聚丙烯网片对子宫主韧带、骶韧带、阴道前后壁、膀胱宫颈韧带进行全盆底悬吊,并根据国际尿控协会制定的盆腔器官脱垂定量(POP-Q)分度法,评价手术效果。结果全盆底悬吊术的中位手术时间为85 min,中位出血量为150 mL。根据POP-Q分度法,184例患者的子宫脱垂、阴道前后壁膨出等症状全部得到纠正,术后无院内感染发生。未观察到其他与手术相关的并发症。所有患者均在术后2～5d出院。术后中位随访时间为12个月,患者的盆底结构基本正常,相关症状消失或明显改善。结论该全盆底悬吊术是一种能治疗多区域、复杂型盆腔器官脱垂的微创手术。在保留子宫的同时能完成全盆底结构和功能的全部或部分重建。短期疗效稳定,长期疗效有待于进一步观察。

Clinical application of total pelvic floor reconstruction in treating female pelvic dysfunction using a modified uterus reserving slingplasty

Objective To explore the effectiveness and safety of a modified uterus reserving slingplasty in the treatment of complex female pelvic organs prolapse.Methods A total of 184 patients with different defects of pel- vic organ prolapse underwent the modified uterus reserving slingplasty.The position of prolapsed pelvic organs,in- cluding the cardinal ligament,uterosacral ligament,anterior and poiterior vaginal wall and plica vesicouterina,was restored with polypropylene mesh.Pelvic organ prolapse quantification(POP-Q)examination was used to evaluate the outcome of treatment.Results The median operating time was 85 minutes and the blood loss during operation was 150 mL.POP-Q examination showed that the prolapsed pelvic organs and bulging of vaginal wall was corrected after operation,with no nosocomial infection and other operation-related complications.All the patients were dis- charged 2-5 days after operation.The pelvic floor was normal during a mean of 12 month follow-up,with the rele- vant symptoms disappeared or improved.Conclusion This modified uterus reserving slingplasty is mini-invasive and can be used for multiple areas and complex POP.It can achieve total or partial pelvic floor reconstruction while reserving the uterus,with stable short-term effect and the long-term effect need further observation.