经阴道改良式全盆底重建手术治疗女性盆腔器官脱垂

Modified transvaginal total pelvic floor reconstruction treats female pelvic organ prolapse:report of 58 cases

目的探讨经阴道改良式全盆底重建手术治疗盆腔器官脱垂的可行性及有效性。方法回顾性分析2007年6月至2008年7月我科收治盆腔器官脱垂(POP)患者58例,年龄42～82岁,孕次1～9次,产次1～8次,发病时间1～360个月。按照盆腔器官脱垂量化分期法(POP-Q)进行分期,阴道前壁膨出Ⅳ期22例,Ⅲ期20例,Ⅱ期10例,Ⅰ期6例。子宫脱垂Ⅳ期26例,Ⅲ期12例,Ⅱ期13例,Ⅰ期7例。阴道后壁膨出Ⅳ期18例,Ⅲ期15例,Ⅱ期11例,Ⅰ期8例,0期6例。合并压力性尿失禁5例。所有患者采用自行修剪补片替代Prolift进行全盆底重建手术。结果手术时间59～200(114±40)min,术中失血量50～400(138±90)ml,术后尿管留置2～4(2.5±0.6)d,术后住院时间为4～8(3.5±1.4)d。术中未出现膀胱、直肠、尿道损伤,术后随访6～12个月,2例术后复发,手术治愈率为96.5%。2例发生补片腐蚀(3.4%),合并压力性尿失禁患者术后无尿失禁发生。术后患者生活质量评分(PFIQ)明显降低[由术前(81.2±28.9)分降低至术后(15.3±8.3)分],术后性生活质量评分(PISQ)无明显改变[术前(66.6±9.1)分,术后(68.0±8.4)分]。结论经阴道改良式全盆底重建手术操作简单、安全、复发率低、术后并发症少,治疗费用低,术后患者生活质量明显提高,是治疗女性盆腔器官脱垂有效的方法。

Objective To evaluate the safety and effectiveness of a modified transvaginal total pelvic floor reconstruction with self-trimmed mesh in female pelvic organ prolapse （POP）. Methods Totally 58 women with identified POP and underging the reconstruction in our department from June 2007 to July 2008 were analyzed retrospectively. These patients, at the age ranging from 42 to 82, had gravidity of 1 to 9 times, parity of 1 to 8 time, and time of prolapse of 1 to 360 months. According to the POP quantitation （POP-Q）. there were 22 cases of stage IV, 20 of stage Ⅲ ; 10 of stage Ⅱ ; and 6 of stage Ⅰ in anterior vaginal wall prolapse ; 26 of stage IV, 12 of stage Ⅲ, 13 of stage Ⅱ and 7 of stage Ⅰ in uterine prolapse; 18 of stage 1V, 15 of stage Ⅲ, 11 of stage Ⅱ , 8 of stage I and 6 of stage 0 in posterior vaginal wall prolapse. Five patients complicated with stress urinary incontinence. All patients undertook the total pelvic floor reconstruction using trimmed mesh to substitute Prolift. Results The mean operation time was 114 ± 40 min （59 to 200） , and the mean blood loss was 138 ＋90 ml （50 to 400）. After the surgery, the mean time of indwelling urethral catheter was 2.5 ±0.6 d （2 to 4）, and the mean post-operative hospital stay was 3.5± 1.4 d （4 to 8）. No complication was observed during and after the surgery. No bladder, rectum and urethra was injured. During the follow-up of 6 to 12 months, all patients except 2 （3.5%） reported satisfaction with the therapeutic results. The average scores of the pelvic floor impact questionnaire （PFIQ） was dropped dramatically from preoperatively 81.2 ± 28.9 to post- operatively 15.3± 8.3, and the average scores of the sexual function questionnaire （PISQ） had no significant difference （66.6± 9.1 preoperatively, 68.0 ± 8.4 postoperatively）. During follow-up, 2 patients were found to have asymptomatic erosion （3.4%）. With regard to the simuhaneous correction of the urine incontinence, all the patients was successful. No case of urine incontinence was observed after the procedure. Conclusion Our modified transvaginal total pelvic floor reconstruction is safe, cheaper and easy to perform with a low rate of postoperative relapse and complications, and it is an effective approach for POP repair. However, long-term efficiency still need further follow-up and observation.