生物补片用于阴道后壁修补术的近期效果初探

The primary study of posterior wall colporrhaphy with biological mesh

目的:初步探讨生物补片用于阴道后壁修补手术的安全性和有效性。方法:2006年1月至5月为阴道后壁膨出6例患者施行生物补片阴道后壁修补术。患者平均年龄55.2岁(40～70岁),体重指数平均27.34(22.60～31.25),POP-Q分度II度4例,III度2例。结果:6例患者总的手术时间平均65min(30～90min),其中放置补片的平均时间为15min。术中平均出血量60ml(10～100ml)。术后患者平均住院4.7天(3～8天),术中及术后未见并发症。随访6例患者平均15.4个月(14.3～17.9个月),随访时行盆腔检查再次POP-Q分度,结果表明,短期内解剖结构得到较为成功的恢复(Bp点较术前减小,P<0.05);并用盆腔器官脱垂-尿失禁患者性生活调查问卷(PISQ)了解患者术后性生活质量,结果表明术后PISQ评分为86.33±8.82,较术前的75.17±13.97上升,虽差异无统计学意义(P>0.05),但提示不影响患者术后性生活的质量。结论:生物补片可用在阴道后壁膨出修补手术中,术后短期随访,解剖结构均恢复达到客观治愈,且不影响患者术后的性生活质量,但有待更多样本、设置对照组及更长时间的观察和研究。

Objective：To investigate the recent effect of the application of biological mesh in posterior wall colporrhaphy. Methods：Posterior wall colporrhaphy with biological mesh was performed on six women between Jan 2006 and May 2006.The average age was 55.2（40-70） years old. Mean BMI was 27.34 （range 22.60-31.25）. Preoperatively 4 patients had stage Ⅱ,and 2 patients had stage Ⅲ prolapse of the posterior vaginal wall with POP-Q evaluation. Two patients were performed vaginal hyster-ectomy ;Four patients were post-menopause. There were 3 patients had previous pelvic surgery. P, Jesuits： The mean operation time was 65 minutes （30-90 minutes）. The mean time of mesh placement was about 15 minutes only. The mean hemorrhage was 60ml（ 10-100ml）. No complications were found in the operation and after operation. The mean period of follow-up after operation was 15.4 months （14.3-17.9 months）. During this time POP-Q evaluation of the pelvic floor was made again to evaluate anatomical outcome. The authors found that the mean point Bp was reduced from -1.33 preoperatively to -3.00（P 〈0.05）. Subjective assessment of sexual function was made utilizing Pelvic Organ Prolapse-Urinary Incontinence Sexual Function Questionnaire （PISQ）. There was no significant difference between preeperation（75.17±13.97） and postoperation（86.33±8.82）. Therefore the biological tresh had not impacted the quality of sexual function. Conclusion ：The application of biological mesh in posterior wall colporrhaphy is easy and simple. During short term follow-up,the anatomical outcome is satisfied and the objective cure is achieved. The biological mesh seems to be very well tolerated by patients with comparable low complication rotes. However,the long term outcome of biological mesh in pelvic floor reconstruction needs further study.