网片重建治疗盆腔器官脱垂的临床疗效及安全性评价

目的:探讨经阴道放置网片的全盆底重建术治疗重度子宫脱垂的临床疗效和安全性。方法:选择2010年7月至2015年6月在青岛大学附属医院因重度盆腔器官脱垂接受全盆底重建术的患者126例,回顾性分析患者的临床资料、生活质量评分及并发症等相关资料。结果:126例患者平均手术时间(67.18±18.00)min,出血量(56.27±26.47)m L,留置尿管(3.47±0.94)天,住院天数(4.21±0.93)天。术后尿潴留的发生率为3.96%、阴道壁血肿0.79%、术后肢体疼痛7.14%、下肢静脉血栓0.79%,所有患者术中均无膀胱或直肠损伤等严重并发症的发生。126例患者中,111例完成随访(88.09%,111/126),随访时间为6~48个月,中位随访时间为27个月。术后发生网片暴露1例(0.9%,1/111),网片挛缩1例(0.9%,1/111),慢性盆腔疼痛2例(1.80%,2/111)、新发尿失禁6例(5.4%,6/111)。其中3例为急迫性尿失禁(2.7%,3/111),3例压力性尿失禁(2.7%,3/111)。盆底重建术后共有3例患者出现复发,其中2例因症状明显再次行手术治疗,客观治愈率的为97.29%(108/111),主观治愈率为98.19%(109/111)。与术前相比,术后6个月、12个月生活质量评分(PFDI-20)均较前均明显降低(P0.05)。术后21例患者恢复性生活,性生活疼痛者3例(14.28%),性生活不适者4例(19.04%),总体性生活满意度为85.71%(18/21)。结论:全盆重建术治疗重度盆腔器官脱垂的疗效较好,且网片相关并发症的发生率较低。

Evaluation of the Clinical Efficacy and Safety of Mesh Reconstruction in the Treatment of Pelvic Organ Prolapse

Objective:To study the efficacy and safety of the total pelvic floor reconstruction for severe pelvic organ prolapsed with transvaginal mesh repair systems.Methods:A retrospective analysis was performed on the clinical data of 110 patients who underwent the total pelvic floor reconstruction including the Scores of PFDI-20 before and after the surgery, complications and other related information from July 2010 to June 2015 in the Affiliated Hospital of Qingdao University.Results:The mean operation time was (67.18± 18.00) min, the blood loss was (56.27± 26.47) mL, the incidence of indwelling urinary catheter was (3.47± 0.94) and the hospitalization stay was (4.21± 0.93) days. The incidence of urinary retention after operation was about 3.96 %, 1 case of vaginal wall hematoma(0.79 %), postoperative limb pain, 9cases(9/126, 7.14 %), vein thrombosis of lower limb, 1 case(0.79 %), all patients showed no bladder or rectal damage and other serious complications. 111 of 126 patients were completely followed up (88.09 %, 111/126) for 6-48 months and the median follow-up time was 27 months. Mesh exposure, 1 case (0.9 %, 1/111); mesh contracture, 1 case (0.9 %, 1/111); 2 cases of chronic pelvic pain (1.80 %, 2/111); 6 cases of urinary incontinence occurred after operation (5.4 %, 6/111), including 3 urge urinary incontinence (2.7 %, 3/111) and 3 cases of stress incontinence (2.7 %, 3/111). Three patients (15.31 %) had recurrence after surgery, 1 of which required reoperation due to cervical extension and mesh exposure. The subjective cure rate was 98.19 % (109/111) and the objective cure rate was 97.29%(108/111). Comparing before and after surgery PFDI-20 score, the difference was statistically significant (P<0. 05); 21 patients had postoperative sexual life, including 3 patients'' spouse felt pain during intercourse, 4 patients not comfortable during intercourse and overall sexual satisfaction is 85.71 %(18/21).Conclusion:Mesh reconstruction might be usefully and safe in the treatment of pelvic organ prolapsed.