全盆底补片悬吊术与传统阴式手术治疗重度盆腔器官脱垂的临床分析

目的:评价传统阴式手术及Prolift TM系统进行全盆底重建术治疗重度盆底器官脱垂的效果,评价其疗效及安全性。方法:回顾性分析2005年1月～2010年1月厦门大学附属第一医院82例患有POP-Q分期Ⅲ期或Ⅳ期的生殖器官脱垂患者,42例施行全盆底重建术(重建组)及40例施行传统手术治疗(阴式子宫切除、阴道前后壁修补以及会阴修补)(传统组)。结果:重建组平均手术时间、术中出血量、术后住院天数分别为(70.75±15.12)min、(98.44±25.02)ml、(5.25±1.23)天,传统组分别为(95.42±16.25)min、(132.60±30.12)ml、(8.34±1.38)天,两组差异均有统计学意义(P<0.05);重建组患者尿管留置时间为(4.85±1.38)天,传统组(5.05±1.4)天,两组比较差异无统计学意义(P>0.05)。重建组术后3个月、6个月及12个月的治愈率分别为97.62%(41/42)、95.24%(40/42)、95.00%(38/40),传统组分别为97.50%(39/40)、92.50%(37/40)、76.92%(30/39),重建组客观治愈率高于传统组,术后3个月及6个月两组间比较差异无统计学意义(P>0.05),1年后两组间比较差异有统计学意义(P<0.05)。结论:Prolifi TM系统全盆底重建术能更好地修补缺陷,恢复盆底结构,短期疗效安全可行,长期疗效有待进一步观察。

Clinical analysis on severe pelvic organ prolapse treated by total pelvic floor patch sling and routine transvaginal surgery

Objective:To evaluate the effects of routine transvaginal surgery and total pelvic floor patch sling(Prolift TM system) in treatment of severe pelvic organ prolapse,assess the clinical efficacy and safety.Methods:82 cases with pelvic organ prolapse(stage Ⅲ or stage Ⅳ according to POP-Q staging) who had visited the hospital from January 2005 to January 2010 were analyzed retrospectively;42 cases received total pelvic floor reconstruction(reconstruction group) and 40 cases received routine surgery(transvaginal hysterectomy,repair of vaginal antetheca and paries posterior,repair of perineum)(routine treatment group).Results:The average operation times,the amounts of blood loss during operation and hospitalization times after operation were(70.75±15.12) minutes,(98.44±25.02) ml and(5.25±1.23) days in reconstruction group,(95.42±16.25) minutes,(132.60±30.12) ml and(8.34±1.38) days in routine treatment group,there was significant difference between the two groups(P<0.05);the times of indwelling urethral catheter in reconstruction group and routine treatment group were(4.85±1.38) days and(5.05±1.4) days,respectively,there was no significant difference between the two groups(P>0.05).The curative rates in reconstruction group at 3,6 and 12 months after operation were 97.62%(41/42),95.24%(40/42) and 95.00%(38/40),respectively,the curative rates in routine treatment group at 3,6 and 12 months after operation were 97.50%(39/40),92.50%(37/40) and 76.92%(30/39),respectively,the objective curative rate in reconstruction group was significantly higher than that in routine treatment group,but there was no significant difference in curative rates at 3 and 6 months after operation between the two groups(P>0.05),there was significant difference in curative rate at 12 months after operation between the two groups(P<0.05).Conclusion:Total pelvic floor reconstruction of Prolift TM system can repair defects and recover pelvic structure better,its short-term efficacy is safe and feasible,and its long-term efficacy needs further observation.