阴道封闭术治疗老年重度盆腔器官膨出26例临床分析

目的:探讨阴道封闭术治疗老年重度盆腔器官膨出(POP)的疗效和安全性。方法:回顾性分析北京协和医院2008年5月至2011年6月因重度POP行阴道全封闭术或阴道半封闭术治疗的26例老年患者病例资料。POP定量分度(POP-Q)法分期均为Ⅲ～Ⅳ期,平均年龄75±5岁(64～89岁)。记录围手术期参数和手术并发症,评价手术的主客观效果和患者满意度等。结果:阴道全封闭术及阴道半封闭术在手术时间和估计出血量方面差异无统计学意义(P>0.05)。所有患者均安全渡过围手术期,顺利恢复自主排尿,1例并发症为阴道血肿。术后大部分患者排尿和排便症状较术前有改善。新发压力性尿失禁1例(3.8%)。患者平均住院费用4488±990元。门诊随诊中位时间3个月(1～10个月),客观治愈率100%;电话随诊中位时间15个月(2～39个月),主观治愈率100%,患者满意率100%。结论:阴道封闭术能缓解多数患者已有的排尿、排便症状,对于无阴道性生活要求的老年重度POP患者是一种安全、经济、疗效满意的术式。

Colpocleisis in Elderly Patients with Severe Pelvic Organ Prolapse: Clinical Analysis of 26 Cases

Objective:To evaluate the efficacy and safety of colpocleisis in treatment of severe pelvic organ prolapse in selected elderly patients.Methods:This was a retrospective case series of women who underwent colpocleisis between May 2008 and June 2011 in Peking Union Medical College Hospital.Twenty-six patients with stage III and IV by POP-Q system were included,with the mean age 75±5 years (64～89 years).Seventeen cases with uterus underwent partial colpocleisis,while nine cases with vaginal vault prolapse underwent total colpocleisis.Anatomic and functional effects were assessed at follow up.Results:The mean operating time was(53±16)minutes in total and (48±13)minutes in partial procedures,without significant difference(P>0.05).The mean blood loss was(48±21)ml in total procedure and (35±13) ml in partial procedure,without significant difference(P>0.05) either.No intraoperative injury and post-operative mortality occurred.All patients were able to recover spontaneous micturation within 5 days.The majority of bothersome bowel and urinary symptoms presented at baseline were resolved,with low rates of de novo urinary incontinence symptoms (3.8%).The average hospital charge was 4488±990yuan.None of the patients had anatomic prolapse recurrence during the median follow-up of 3 months (1～10 months).A telephone interview performed after a median of 15 months (2～39 months) showed satisfaction with the operation and subjective cure in all of cases.Conclusions:Colpocleisis could relieve prolapse and pelvic symptoms in most patients.Colpocleisis represents a safe,economic and effective treatment for severe POP in selected elderly patients with satisfactory outcomes.