聚丙烯网片在女性盆底重建手术中的应用

目的:初步探讨聚丙烯网片在女性盆底重建手术中的近期疗效和安全性。方法:从2008年8月～2010年7月上海市长宁区妇幼保健院采用聚丙烯网片完成盆底重建手术共119例。术前按盆腔器官脱垂定量(POP-Q)分期,其中Ⅲ度以上膀胱膨出、子宫脱垂及直肠膨出分别为84例(70.6%)、64例(53.8%)、19例(16.0%),阴道穹窿膨出4例(3.4%),同时存在2个以上部位缺陷91例(76.5%)。结果:前、后盆底重建及全盆底重建术各54例、13例及52例,其中保留子宫55例(46.2%),同时行经闭孔尿道中段悬吊术65例(54.6%)。术后平均随访时间17.8个月,网片外露6例(5.0%),新发膀胱过度活动症6例(5.0%),压力性尿失禁4例(3.4%),无症状膀胱Ⅱ度膨出3例(2.5%)。术后6月前盆底重建组Aa及C点值,后盆底重建组Ap及C点值,全盆底重建组Aa、Ap及C点值与术前比较差异均有统计学意义(P<0.05)。结论:应用聚丙烯网片的盆底重建手术是一种安全又经济的术式,可以同时治疗压力性尿失禁和保留脱垂的子宫,手术近期疗效满意,远期效果有待进一步随访观察。

Application of polypropylene mesh in female pelvic floor reconstruction surgery

Objective:To explore the short-term effect and safety of polypropylene mesh in female pelvic floor reconstruction surgery.Methods:From August 2008 to July 2010,a total of 119 patients received pelvic floor reconstruction surgery with polypropylene mesh in the hospital.The patients were staged according to pelvic organ prolapse quantitative examination(POP-Q) before surgery,84 patients(70.6%),64 patients(53.8%),and 19 patients(16.0%) were found with cystocele of more than stage Ⅲ,uterine prolapse,and rectocele,respectively;4 patients(3.4%) were found with fornix vaginal bulge,and 91 patients(76.5%) were found with defects of more than two positions.Results:Fifty-four patients,thirteen patients,and fifty-two patients received anterior,posterior,and total pelvic floor reconstruction surgery,respectively,and 55 patients(46.2%) preserved the uterus;65 patients(54.6%) underwent transobturator inside-out urethral suspension.The mean follow-up time after surgery was 17.8 months.Six patients(5.0%),six patients(5.0%),four patients(3.4%),and three patients(2.5%) were found with mesh exposure,new-onset overactive bladder,stress incontinence,and asymptomatic cystocele of stage II,respectively.There was statistically significant difference in the values at Ap points and C points in anterior pelvic floor reconstruction surgery group,posterior pelvic floor reconstruction surgery group,and total pelvic floor reconstruction surgery group between at six months after surgery and after surgery(P<0.05).Conclusion:Pelvic floor reconstruction surgery with polypropylene mesh is safe and economic,which can cure stress incontinence and preserve the prolapsed uterus with satisfactory short-term efficacy,while the long-term efficacy needs further follow-up and observation.