盆底重建术中应用补片对患者生活质量影响的评价

Effect of pelvic reconstruction surgery with synthetic mesh on improving the short term quality of life in patients with pelvic organ prolapse

目的评价应用合成补片进行盆底重建手术对患者生活质量的影响。方法2006年3月～2007年8月我科应用合成补片对POP-Q分期Ⅲ～Ⅳ期的盆腔脏器脱垂患者进行盆底重建手术。患者术前及术后填写生活质量调查问卷(PFDI-20短表)。术后定期复查,判定主客观复发情况。采用单因素方差分析、配对资料的t检验。结果可进行生活质量评价的盆底重建手术患者39例。前盆腔缺陷92.3%,中盆腔缺陷74.4%,后盆腔缺陷33.3%。术前PFDI-20总评分(15.05±6.77)分,手术后2个月、半年、1年和1年半的PFDI-20评分分别降为(1.48±4.20)分、(4.44±5.93)分、(2.46±2.60)分和(3.40±2.79)分,P均<0.05,而术后各组的评分间差异无统计学意义,(P>0.05)。术后POPDI-6(盆腔脏器脱垂)、CARDI-8(肠道脱垂)和UDI-6(排尿相关症状)评分下降,与术前相应评分相比,差异具有显著意义(P<0.05)。36例患者随访2～17个月(平均7.1个月),近期主观治愈率100%,客观治愈率97.2%。无补片侵蚀发生。结论盆腔脏器脱垂对患者的生活质量有明显影响,盆底重建手术中使用补片疗效肯定,可显著改善患者术后近期的生活质量。但需要延长随访时间,观察长期疗效。

Objective evaluate the effect of pelvic reconstructive surgery with synthetic mesh on patients＇ quality of life （QOL）. Methods From March 2006 to August 2007, women with pelvic organ prolapse （POPQ stageⅢ～Ⅳ） underwent pelvic reconstructive surgery with synthetic mesh in our department were studied. Pelvic symptoms, recurrence of prolapse and QOL were evaluated preoperatively and at postoperative follow - up using the Pelvic Floor Distress Inventory short form 20 （PFDI20）. Results The mean age of 39 patients, who could be evaluated for QOL, was 68. 1 years （55～84 years）; mean weight index was 23. 6 （16. 8～30. 4）. The preoperative diagnosis were： anterior compartment defect （92. 3%）, middle compartment defect （74. 4%） and posterior compartment defect （33. 3%）. Preoperative PFDI20 score was （15. 05±6. 77）, demonstrated an obvious impact on their quality of life. Patients had statistically lower scores when they were followed up at 2 months, 6 months, 1 year and 1. 5 years after the operation, （1.48±4. 20）, （4. 44±5. 93）, （2.46±2. 60） and （3. 40±2. 79） respectively, all P〈0. 05. While no significant differences presented among scores at different postoperative time （P〉0. 05）. Pelvic organ prolapse distress inventory （POPDI6）, colorectalanal distress inventory 8 （CARDI8） and urinary distress inventory 6 （UDI6） scores decreased significantly after the operation （all P〈0. 05） . However, two patients suffered from moderate or severe stress urine incontinence, increasing of UDI6 scores. The mean follow- up was 7. 1 months （2～17 month）, with a follow - up rate of 92. 3% （36/39）. The short term objective cure rate was 100%, subjective cure rate was 97.2% and 2. 8% （1/36） reported subjective recurrence. No mesh erosion or infection occurred. Conclusions Pelvic reconstruction surgery with mesh present good effect on improving the short term quality of life in patients. However, further follow - up is needed to observe the long term effects.