脱细胞生物组织补片在盆底重建手术中的应用

目的初步探讨脱细胞生物组织补片在盆腔器官膨出患者盆底重建手术中的应用情况。方法选择北京大学人民医院妇科2006年5月至12月期间接受盆底修补和重建手术并应用脱细胞生物补片的盆腔器官膨出患者20例,其中子宫脱垂19例,子宫切除术后阴道穹隆脱垂Ⅱ度1例;合并存在膀胱膨出20例、直肠膨出17例。20例患者中17例同时行阴道前后壁修补术,3例行阴道前壁修补术;阴道前壁置入补片15例,阴道后壁置入补片2例,阴道前壁和后壁同时置入补片3例。结果20例患者总手术时间平均为113．1min（70～180min）,其中放置补片的时间平均为10min。术中出血平均为175ml（50～300ml）。术后恢复良好,平均随访9．3个月（6～12个月）,未发现补片侵蚀阴道黏膜情况,无感染发生。随访期间4例（20％）患者出现盆腔器官膨出复发,3例为膀胱膨出Ⅰ度,复发时间均为6个月复查时,其中2例随访12个月时仍为膀胱膨出Ⅰ度,另1例随访8个月时也为膀胱膨出Ⅰ度,未见加重;1例为膀胱膨出Ⅱ度,复发时间为6个月复查时;所有复发患者均无临床症状。结论脱细胞生物组织补片用于盆底重建手术,方法简单,操作容易,未见补片侵蚀发生,其长期效果有待进一步观察。

Application of acellular dermal mesh in female pelvic reconstruction surgery

OBJECTIVE: To investigate the application of acellular dermal mesh in female pelvic reconstruction surgery. METHODS: Twenty patients underwent the operation for pelvic organ prolapse, who were admitted from May 2006 to December 2006 into Peking University People's Hospital. Acellular dermal mesh was used for pelvic floor reconstruction in the operation. The average age was 66 (43-77) years. The number of patients with the uterine prolapse was 19, and the other one patient was vaginal vault prolapse. Twenty cases had the anterior vaginal wall prolapse, and 17 cases were with the posterior vaginal wall prolapse. Fifteen cases received anterior vaginal wall reparation with acellular dermal mesh, and 2 cases received the posterior vaginal wall reparation with acellular dermal mesh. Both of the anterior and posterior vaginal walls were repaired with acellular dermal mesh in 3 cases. RESULTS: The mean operation time was 113.1 minutes (70-180 minutes). The mean time of mesh placement was about 10 min only. The mean hemorrhage was 175 ml (50-300 ml). All the patients recovered well after operation. The mean period of follow-up after operation was 9. 3 months (6-12 months). No erosion or infection was found. Four cases of recurrence (20% )were found. Three cases of them were of stage I recurrence with no symptoms. One case of them was of stage II recurrence with no symptoms. And the recurrences were found at a half year after operation. CONCLUSIONS: The application of acellular dermal mesh in female pelvic reconstruction surgery is easy and simple. Patient tolerance is good. However, the long term effect is still uncertain.