利用移植物的盆底重建手术并发症分析及处理

目的探讨利用移植物的盆底重建手术的并发症及处理。方法收集2006年2月至2009年7月北京大学第一医院妇产科行利用移植物的盆底重建手术的中重度盆腔器官脱垂患者176例的临床资料,分析其手术并发症及处理情况。结果①术中无并发症发生。②术后近期并发症发生率为2.27%(4/176),其中1例(0.57%)泌尿系感染;1例(0.57%)臀下方大腿右侧深部血肿;2例(1.14%)便失禁。③176例患者中,共随访151例,术后远期并发症发生率为35.76%(54/151)。其中38例(25.17%)出现补片侵蚀,4例再次侵蚀;2例(1.32%)阴道抽痛;3例(1.99%)大腿根部疼痛或不适;1例(0.66%)阴道中部粘连;3例(1.99%)尿道口疼痛;4例(2.65%)大便坠涨感及肛门不适;2例(1.32%)排便困难;1例(0.66%)会阴疼痛。④术后补片侵蚀与绝经、绝经年限、是否合并糖尿病、手术时间、术中出血量及术后最高体温无关(P0.05),与年龄呈正相关(r=0.921,P=0.012),侵蚀高发年龄为47～55岁及63岁以上。结论利用移植物的盆底重建手术有一定的术后并发症,选择手术方式时应综合考虑。

Analysis and managment of complications of pelvic floor reconstructive surgery with graft

Objective To investigate the complications of pelvic floor reconstructive surgery with graft and the managment of them. Methods A total of 176 patients with moderate to severe pelvic organ prolapse （POP） who underwent pelvic floor reconstructive surgery with graft at the Obstetrics and Gynecology Department of Peking University First Hospital from February 2006 to July 2009 were recruited in this study.The complications and treatments were analysed.Results ① There had no intraoperative complications occurred.② The incidence of short term postoperative complications was 2.27% （4/176）,including 1 case of urinary tract infection （0.57%）,1 case of hematoma in the right thigh deep beneath hip （0.57%） and 2 cases of fecal incontinence （1.14%）.③ 151 cases of the 176 patients were under followe-up.Incidence of long-term complications after surgery was 35.76% （54/151）.38 mesh erosion occurred （25.17%） in which 4 cases had re-erosion. There were two cases of vaginal lancinating （1.32%）,three cases of thigh pain or discomfort （1.99%）,one with vaginal adhesion （0.66%）,three with urethral pain （1.99%）,four with falling and inflation sense of anus （2.65%）,two with difficult defecation（1.32%）and one with perineum pain （0.66%）.④ Postoperative mesh erosion was not related with menopause,diabetes,operative time,blood loss and postoperative maximum body temperature （P0.05）,but it was age-related （r=0.921,P=0.012）. The high incident ages of erosion were 47~55 years and older than 63 years. Conclusion The pelvic floor reconstructive surgery with graft may bring some postoperative complications to patients. Surgical options should be carefully considered.