聚丙烯网片在女性全盆底功能重建中的应用

Organ reserved pelvic floor reconstruction using gynemesh

目的探讨应用聚丙烯网片在保留子宫的同时进行盆底重建的可行性和有效性。方法对同济大学附属同济医院妇产科2005年3月至2007年2月收治的66例有不同缺陷的女性盆腔器官脱垂患者应用聚丙烯网片进行全盆底悬吊,具体包括:采用聚丙烯网片悬吊双侧子宫主韧带、骶韧带,并将网片置入膀胱阴道筋膜和直肠阴道筋膜,同时进行肛提肌及会阴体的修复从而完成盆底3个平面的重建。合并有压力性或混合尿失禁的患者同时行尿道中段无张力悬吊术。结果手术时间平均为95min,出血量平均为120mL,根据POP-Q分度法,66例患者的子宫脱垂、阴道前后壁膨出等症状全部得到纠正,术后无院内感染发生,未观察到其它与手术相关的并发症。术后随访平均11个月,患者的盆底结构基本正常,相关症状消失或明显改善。结论应用聚丙烯网片进行全盆底悬吊是一种微创而又经济的盆底重建术,该手术在保留子宫的同时能完成全盆底结构和功能的全部或部分重建。中、短期疗效稳定,长期疗效有待进一步观察。

Objective To explore the feasibility and efficiency of organ reserved total female pelvic floor reconstruction by using polypropylene gynemesh in treating female pelvic organ prolapse（POP）. Methods Totally 66 patients with different severity of POP underwent pelvic floor reconstruction operation without hysterectomy. The polypropylene gynemeshes were inserted both into vesico-vaginal fascia and recto-vaginal fascia to sling uterocardinal ligaments and uterosacral ligaments, Levator ani muscle and perineal body were also repaired using the standard procedures, Patients with stress or mixed incontinence were treated with modified tension free transvaginal sling at the same time. Results The average operating time was 95 min with average 120mL blood loss. No operation-associated complications were observed. No nosocomial infection occurred after operation as well. According to POP-Q system, all the patients＂ uterine and vaginal wall prolapse were restored. Their pre-operation symptoms disappeared or were improved significantly. The average follow-up was 11 months and the results remained stable. Conclusion Organ reserved total female pelvic floor reconstruction by using polypropylene gynemesh in treating female pelvic organ prolapse is a minimally invasive and safe procedure. It is also a cost,effective procedure. This surgery has a stable middle and short-term curative effect while its long-term effect needs to be investigated.