中国医学科学院学报

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中国医学科学院学报

中国医学科学院学报 ›› 2011, Vol. 33 ›› Issue (2): 180-184.doi: 10.3881/j.issn.1000-503X.2011.02.016

• 论著 • 上一篇    下一篇

应用全盆底重建术治疗重度盆腔器官脱垂临床分析

刘小春,朱 兰,郎景和,史宏晖,龚晓明,李 琳,范 融   

  1. 中国医学科学院 北京协和医学院 北京协和医院妇产科,北京 100730
  • 收稿日期:2010-07-23 出版日期:2011-04-10 发布日期:2011-04-10
  • 通讯作者: 朱兰 电话:010-88068222 E-mail:tyxchliu@163.com
  • 基金资助:

    国家十一五科技支撑计划(2007BAI04B05)

Total Pelvic Floor Reconstruction Surgery for Repair of  Severe Pelvic Organ Prolapse

LIU Xiao-Chun, ZHU Lan, LANG Jing-He, SHI Hong-Hui, GONG Xiao-Ming, LI Lin, FAN Rong   

  1. Department of Gynaecology and Obstetrics, PUMC Hospital, CAMS and PUMC, Beijing 100730, China
  • Received:2010-07-23 Online:2011-04-10 Published:2011-04-10
  • Contact: ZHU Lan Tel:010-88068222 E-mail:tyxchliu@163.com
  • Supported by:

    the National Key Technology R&D Program during the 11th FiveYear Plan Period(2007BAI04B05)

摘要: 目的 评价全盆底重建术治疗女性重度盆腔器官脱垂的解剖及功能疗效。方法 回顾性分析21例重度盆腔器官脱垂行全盆底重建术的临床资料,通过盆腔器官脱垂定量分期法评价解剖疗效,生活质量问卷评价功能疗效,分析性生活问卷及术中术后并发症情况。结果手术由相同医师完成,未发生膀胱、直肠、大血管损伤,无输血病例。手术时间 (63±19) min (40~100-min),出血(143±72)ml(50~300-ml)。除1例术后尿潴留外,其余均1~2-d恢复自主排尿。3例(14.3%)术后病率。3例(14.3%)网片侵蚀。12例有性生活者,术后新发性交痛及性交困难各2例。新发压力性尿失禁及膀胱过度活动症各1例。评分显示术后生活质量显著提高(P= 0.000),而性生活质量降低(P=0.044)。解剖治愈率95.2%(20/21),患者主观满意度85.7%(18/21)。结论 全盆底重建术用于纠正重度盆腔器官脱垂手术安全、解剖恢复率高、功能恢复不及解剖恢复。网片侵蚀、新发下尿路症状、性交痛及性交困难等并发症不容忽视。

关键词: 盆腔器官脱垂, 全盆底重建术, 临床分析, 并发症

Abstract: Objective To evaluate clinical effectiveness of total pelvic floor reconstruction surgery for repair of severe pelvic organ prolapse. Methods We retrospectively analyzed the clinical data of 21 patients with severe pelvic organ prolapse. The anatomical outcomes were evaluated by Pelvic Organ Prolapse Quantitation, functional effectiveness by Prolapse Quality of Life method, and sexual function and operation-related complications were also analyzed. Results All surgical operations were accomplished successfully by the same surgeon. No impairment of bladder, urethra, rectum, or great vessels was noted, and no patient required blood transfusion. The mean operation duration was (63±19) minutes, and the mean intra-operative blood loss was (143±72) ml. One patients experienced post-operative urinary retention for 7 days, and the remaining 20 patients were able to micturate spontaneously 1-2 day after surgery. The post-operative morbidity rate was 14.3%. Three patients (14.3%) experienced mesh erosion. Of 12 patients who were sexually active, two patients suffered from algopareunia,two from dyspareunia, one from de novo overactive bladder, and one from stress urinary incontinence  Questionnaire scores showed that the overall post operative quality of life was improved significantly (P=0.000), while quality of sexual life significantly degraded (P=0.044) The anatomic cure rate was 95.2% (20/21), and the patient subjective satisfaction rate was 85.7% (18/21) Conclusions The total pelvic floor reconstruction is a safe and effective approach for the repair of severe pelvic organ prolapse, although its functional effectiveness is not as notable as anatomical outcomes However, the complications such as mesh erosion, low urinary tract symptoms, algopareunia, and dyspareunia should be carefully managed

Key words: pelvic organ prolapse, total pelvic floor reconstruction, clinical analysis, complications

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