改良盆底重建术与传统手术治疗盆腔器官脱垂的随访评价

目的:评价经阴道全子宫切除术加改良盆底重建术和经阴道全子宫切除术加阴道前后壁修补术治疗盆腔脏器脱垂的治疗效果。方法:对2007年4月至2011年4月盆腔脏器脱垂Ⅱ～Ⅳ度102例患者进行术后3个月、6个月、12个月、36个月随访,其中经阴道子宫切除术加改良盆底重建术(重建组)65例,经阴道子宫切除术加阴道前后壁修补术(传统组)37例。采用POP-Q分度法,Ⅱ度及Ⅱ度以上判定为复发。结果:重建组2例(3.08%)复发,传统组6例(16.21%)复发,两组复发率差异有统计学意义(P<0.05);重建组复发患者均合并网片侵蚀、外露,剪除外露网片并局部雌激素治疗后放置子宫托,目前疗效满意;传统组复发患者分别行子宫托治疗、改良盆底重建术、Prolift盆底重建术、阴道封闭术,目前疗效满意;重建组35例术后恢复性生活,传统组25例术后恢复性生活,性功能问卷评分均较术前下降(P<0.05),但两组术后性功能评分无显著差异(P>0.05)。结论:改良盆底重建术作为一种新术式,能更好地修补缺陷、实现结构重建和组织替代,其复发率低,尤其是对于Ⅲ～Ⅳ度脱垂患者较传统手术更具优势。术后复发患者首选子宫托治疗,传统组可行网片再次手术治疗,阴道封闭术为最后的选择方法。

Curative effect comparison of modified pelvic floor reconstruction and traditional operation in treatment of pelvic organ prolapse

Objective:To evaluate the treatments of pelvic organ prolapse by transvaginal hysterectomy+modified pelvic floor reconstruction and transvaginal hysterectomy+anterior and posterior vaginal wall repair.Methods:102 cases of pelvic organ prolapse in Ⅱ~Ⅳ degree from April 2007 to April 2011 were collected.65 cases underwent transvaginal hysterectomy+modified pelvic floor reconstruction(reconstruction group)and 37 cases underwent transvaginal hysterectomy+anterior and posterior vaginal wall repair(traditional group).After a follow-up of 3,6,12,36 months,the patients of POP-Q in Ⅱ and more than Ⅱ degree were judged to be recurrence.Results:2(3.08%)patients recurred in reconstruction group,6 patients(16.21%)recurred in traditional group recurrence,two groups of the recurrence rate was statistically significant difference(P<0.05).Reconstruction group recurrence of the patients with nets exposed erosion,cut off exposed mesh and treated with local estrogen therapy.At present the results were satisfactory.Traditional group patients of recurrence were treated with the pessry,Prolift pelvic revascularization,revascularization vaginal closed surgery,respectively.At present the results were satisfactory.35 cases of sexual life in reconstruction group and 25 cases of sexual life in traditional group after surgery.The sexual function questionnaire scores were compared with preoperative decreased(P<0.05),but the two group of postoperative sexual function score was not significantly different(P>0.05).Conclusion:Modified pelvic floor reconstruction as a new technique,better able to repair defects,to realize the structure reconstruction and tissue replacement,the recurrence rate is low.Compared with the traditional operation it has an advantage more especially for Ⅲ~Ⅳ degree prolapse patients,short curative effect is stable,long-term efficacy remains to be further observation.Pessary can be selected firstly in postoperative recurrence patients.