改良全盆底悬吊术治疗女性盆底障碍性疾病临床研究

Clinical research on modified total pelvic floor sling in treatment of female pelvic floor dysfunction

目的:探讨改良全盆底悬吊术治疗女性盆底障碍性疾病的效果。方法:对28例根据POPQ分度法达Ⅲ度及Ⅲ度以上盆底障碍性疾病的女性患者行改良全盆底悬吊术,应用自制聚丙烯网片对子宫主韧带、骶韧带、阴道前后壁、膀胱宫颈韧带进行全盆底悬吊,合并压力性尿失禁的患者同时进行改良经闭孔尿道中段无张力悬吊术(改良TVT-O术)。结果:28例患者手术全部完成,平均手术时间(92.5±10.4)min,术中平均出血(120.7±45.5)ml,平均住院时间(3.5±2.8)d,术后随访平均为8个月。根据POPQ分度法及问卷评价手术效果,28例患者手术后盆腔器官脱垂症状全部得以纠正,盆底结构基本正常,所有病例全部治愈。结论:上述改良全盆底悬吊术是一种能治疗多区域、复杂型盆腔器官脱垂的微创手术。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,手术方法安全、微创。

Objective：To explore the effectiveness of modified pelvic floor sling in treatment of female pelvic floor dysfunction（PED）.Methods：28 female patients with PED of grade Ⅲ or above Ⅲ according to POPQ underwent modified pelvic floor sling,self-made polypropylene mesh was used to hang cardinal ligament of uterus,utero-sacral ligament,vaginal anterior wall and back wall and cervical ligament of bladder,for the patients combined with stress urinary incontinence,modified tension-free vaginal tape-obturator（TVT-O）was conducted.Results：The operation was finished completely,the average operative time was（92.5±10.4）minutes,the average blood loss was（120.7±45.5）ml during operation,the hospitalization time was（3.5±2.8）days,the patients were followed up for 8 months after operation,the symptom of pelvic organ prolapse in 28 patients was cured after operation according to POPQ and questionnaires,the pelvic floor structure returned to normal,all the patients were cured.Conclusion：Modified total pelvic floor sling is a mini-invasive surgery,which can cure multi-region and complex pelvic organ prolapse,and reconstruct pelvic floor structure and function completely or partially with the advantages of safety and mini-invasion.