改良全盆底重建术治疗重度盆腔器官脱垂的近期疗效

Short-term therapeutic effect of modified total pelvic floor reconstruction in treatment of severe pelvic organ prolapse

目的 评价改良全盆底重建术治疗重度盆腔器官脱垂的近期疗效.方法 对39例经盆腔器官脱垂定量（POP-Q）分度法诊断为重度子宫脱垂（包括穹隆脱垂）的患者行改良全盆底重建术,并分析围手术期及术后12个月各项治疗评价指标的变化及并发症发生情况.结果 中位手术时间为70 min（30～240 min）,中位术中出血量100 ml（10～200 ml）;77%（30/39）的患者手术次日晨即拔除尿管,且残余尿量〈100 ml;无术中严重并发症发生;术后病率为20%（8/39）;术后中位住院时间为4 d（1～11d）.中位随访时间24个月（13～29个月）.以POP-Q评分为疗效的客观评价指标,手术有效率达100%;5%（2/39）的患者于术后24个月内出现症状性复发（阴道后壁膨出）：8%（3/39）的患者术后7个月内发生阴道侧壁或后壁网片侵蚀;5%（2/39）的患者出现新发的急迫性尿失禁;另有8%（3/39）的患者出现新发的便秘;发生率最高的并发症为性交困难（36%,5/14）,但有50%（7/14）的患者术后性生活改善.结论 改良全盆底重建术是治疗重度盆腔器官脱垂的一种安全、有效的手术方式,但其对术后性生活的影响应受到重视.

Objective To evaluate short-term clinical effects of modified total pelvic floor reconstruction surgery in treatment of severe pelvic organ prolapse.Methods Thirty-nine cases with severe pelvic organ prolapse including vault prolapse diagnosed by pelvic organ prolapse quantification （POP-Q） system received modified total pelvic floor reconstruction surgery.Clinical parameters associated peri-operative period and 12 months after surgery and complications were analyzed Results Median operation time was 70 minutes （30-240 minutes）,median blood loss was 100 ml （10-200 ml）.Seventy-seven percent （30/39） patients were able to micturate spontaneously in the next morning after surgery with postvoid residual volume less than 100 ml （0-650 ml）.No severe intra-operative complications were recorded and the rate of postoperative morbidity was 20% （8/39 ）.Median post-operative hospital stay was 4 days （1-11 days）.The patients were followed up at median 24 months（13-29 months）.According to POP-Q system evaluation,the successful rate of operation reached 100% .Two cases （5%,2/39） were recorded as symptomatic recurrence which manifested as posterior wall prolapse within 24 months after operation.During follow-up,8% （3/39） patients were found to have erosion within 7 months after surgery,and urgent urinary incontinence was observed in 5% （2/39） cases,while constipation occurred in 8% （3/39） cases.The most remarkable complication was dyspareunia （36%,5/14）; while 50% （7/14） experienced better sexual life after surgery.Conclusions Modified total pelvic reconstruction is a safe,efficient and micro-invasive surgery in treatment of severe pelvic organ prolapse.However,its influence on post-operative sexual life should be concerned.